Provider Demographics
NPI:1396871752
Name:MILLER, YELENA ALEKSANDRIA
Entity type:Individual
Prefix:
First Name:YELENA
Middle Name:ALEKSANDRIA
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6015 WATT AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HIGHLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:95660-4294
Mailing Address - Country:US
Mailing Address - Phone:916-874-5437
Mailing Address - Fax:
Practice Address - Street 1:6015
Practice Address - Street 2:
Practice Address - City:WATT AVE
Practice Address - State:CA
Practice Address - Zip Code:95666
Practice Address - Country:US
Practice Address - Phone:916-875-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA834591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical