MEDICARE: NICKIA M MILLER LADC, LCSW

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	1121	CT
2	101YM0800X	Mental Health Counselor	12263	CT
3	1041C0700X	Clinical Social Worker	12263	CT

General Provider Information

NPI Number	:	1437514080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICKIA M MILLER LADC, LCSW

Provider Business Mailing Address
First Line	:	477 CONNECTICUT BLVD STE 117
Second Line	:
City	:	EAST HARTFORD
State	:	CT
Zip	:	06108-3228
Country	:	US
Telephone Number	:	860-838-8140
Fax Number	:

Provider Business Practice Location Address
First Line	:	477 CONN BLVD STE 117
Second Line	:
City	:	EAST HARTFORD
State	:	CT
Zip	:	06108-3228
Country	:	US
Telephone Number	:	860-838-8140
Fax Number	:

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

Provider Enumeration Date	:	12/28/2015
Last Update Date	:	04/13/2026

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