Provider Demographics
NPI:1386080406
Name:MILLER, MICHELLE E (LCSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:E
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:PO BOX 95000
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-4655
Mailing Address - Country:US
Mailing Address - Phone:800-444-6020
Mailing Address - Fax:845-256-1881
Practice Address - Street 1:279 MAIN ST
Practice Address - Street 2:102
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1623
Practice Address - Country:US
Practice Address - Phone:845-255-2930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY088504104100000X
NY08492011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker