MEDICARE: SUSAN E MILLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	23609	CA

General Provider Information

NPI Number	:	1245361534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN E MILLER

Provider Business Mailing Address
First Line	:	1139 N BRAND BLVD STE A
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91202-3012
Country	:	US
Telephone Number	:	323-775-7596
Fax Number	:

Provider Business Practice Location Address
First Line	:	1139 N BRAND BLVD STE A
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91202
Country	:	US
Telephone Number	:	323-775-7596
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	07/10/2018

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Directions to “ SUSAN E MILLER ” Practice Location

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