MEDICARE: MALIKKA 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	104100000X	Social Worker	1	NY
2	252Y00000X	Early Intervention Provider Agency
3	1041C0700X	Clinical Social Worker	102438	NY

General Provider Information

NPI Number	:	1629571971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALIKKA MILLER

Provider Business Mailing Address
First Line	:	2700 WESTCHESTER AVE STE 300
Second Line	:
City	:	PURCHASE
State	:	NY
Zip	:	10577-2554
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 GRAMATAN AVE APT F71A
Second Line	:
City	:	MOUNT VERNON
State	:	NY
Zip	:	10552-3243
Country	:	US
Telephone Number	:	914-575-9801
Fax Number	:

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

Provider Enumeration Date	:	03/13/2018
Last Update Date	:	05/14/2026

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Directions to “ MALIKKA MILLER ” Practice Location

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