Provider Demographics
NPI:1215137872
Name:MILLER, CLIFFORD C (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:C
Last Name:MILLER
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 W CLINTON ST
Mailing Address - Street 2:APT. 48
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-1809
Mailing Address - Country:US
Mailing Address - Phone:574-534-8749
Mailing Address - Fax:
Practice Address - Street 1:2400 W CLINTON ST
Practice Address - Street 2:APT. 48
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-1809
Practice Address - Country:US
Practice Address - Phone:574-534-8749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001753A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN34001753AOtherCLINICAL SOCIAL WORKER -