Provider Demographics
NPI:1063671295
Name:MILLER, JESSICA L (LCSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:MILLER
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 SW 26TH TER APT A
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-7049
Mailing Address - Country:US
Mailing Address - Phone:561-251-9623
Mailing Address - Fax:
Practice Address - Street 1:3905 SW 26TH TER APT A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-7049
Practice Address - Country:US
Practice Address - Phone:561-251-9623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW240701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical