Provider Demographics
NPI:1104964683
Name:MILLER, LAURA B (LCSW, CEAP)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:B
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22512
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92192-2512
Mailing Address - Country:US
Mailing Address - Phone:858-337-3626
Mailing Address - Fax:858-366-7454
Practice Address - Street 1:5752 OBERLIN DR
Practice Address - Street 2:SUITE 106
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1747
Practice Address - Country:US
Practice Address - Phone:858-337-3626
Practice Address - Fax:858-366-7454
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS151261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical