Provider Demographics
NPI:1285871491
Name:MILLER, SHAYNEE S (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SHAYNEE
Middle Name:S
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 WALTON ST
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-3033
Mailing Address - Country:US
Mailing Address - Phone:516-639-5881
Mailing Address - Fax:516-485-8257
Practice Address - Street 1:318 WALTON ST
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-3033
Practice Address - Country:US
Practice Address - Phone:516-639-5881
Practice Address - Fax:516-485-8257
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO25211-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPRO25211-1OtherNYS DEPARTMENT OF EDUCATION - CLINICAL SOCIAL WORKER