Provider Demographics
NPI:1124082425
Name:MILLER, MARILYN M (ISW)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:ISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 NE 125TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5611
Mailing Address - Country:US
Mailing Address - Phone:305-899-1587
Mailing Address - Fax:
Practice Address - Street 1:18999 BISCAYNE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2814
Practice Address - Country:US
Practice Address - Phone:305-933-9820
Practice Address - Fax:305-933-9843
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW26111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical