MEDICARE: JENNIFER MILLER MSW, 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	104100000X	Social Worker	13034	LA
2	1041C0700X	Clinical Social Worker	0904010115	VA

General Provider Information

NPI Number	:	1912366576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MILLER MSW, LCSW

Provider Business Mailing Address
First Line	:	8318 SHAGREEN CT
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23838-5126
Country	:	US
Telephone Number	:	410-596-3436
Fax Number	:

Provider Business Practice Location Address
First Line	:	9850 LORI RD STE 101
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-6758
Country	:	US
Telephone Number	:	804-621-4034
Fax Number	:	804-621-4091

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

Provider Enumeration Date	:	02/11/2016
Last Update Date	:	03/17/2018

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