Provider Demographics
NPI:1124301551
Name:MILLER, SCOTT E (LCSW)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:E
Last Name:MILLER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:868 WOODSMANS MILL RD
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04941-4640
Mailing Address - Country:US
Mailing Address - Phone:207-322-1112
Mailing Address - Fax:
Practice Address - Street 1:868 WOODSMANS MILL RD
Practice Address - Street 2:
Practice Address - City:MONTVILLE
Practice Address - State:ME
Practice Address - Zip Code:04941-4640
Practice Address - Country:US
Practice Address - Phone:207-322-1112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0395641041C0700X
MELC141371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE400158817Medicare UPIN
MEE400172246Medicare PIN