Provider Demographics
NPI:1568781177
Name:MILLER, SEAN A (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:A
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 1:3120 LEWIS DR
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62305-6424
Mailing Address - Country:US
Mailing Address - Phone:217-316-5060
Mailing Address - Fax:
Practice Address - Street 1:418 N 24TH ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-3254
Practice Address - Country:US
Practice Address - Phone:217-231-1058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-21
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20220143571041C0700X
IL149.0140621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical