Provider Demographics
NPI:1568685311
Name:MILLER MANDELL, DIANE JACQUELINE (MSSA LISW)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:JACQUELINE
Last Name:MILLER MANDELL
Suffix:
Gender:F
Credentials:MSSA LISW
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Other - First Name:
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Mailing Address - Street 1:7577 CENTRAL PARKE BLVD
Mailing Address - Street 2:219
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-6809
Mailing Address - Country:US
Mailing Address - Phone:513-770-3231
Mailing Address - Fax:513-770-5541
Practice Address - Street 1:7577 CENTRAL PARKE BLVD
Practice Address - Street 2:219
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-6809
Practice Address - Country:US
Practice Address - Phone:513-770-3231
Practice Address - Fax:513-770-5541
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHI00050851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical