Provider Demographics
NPI:1699873679
Name:MILLER, LYNN MARIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:MILLER-ALBAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:36 OAK TREE LN
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2232
Mailing Address - Country:US
Mailing Address - Phone:714-319-4707
Mailing Address - Fax:
Practice Address - Street 1:11770 WARNER AVE
Practice Address - Street 2:STE 110
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-2659
Practice Address - Country:US
Practice Address - Phone:714-963-1059
Practice Address - Fax:714-968-5276
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS144421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LCS14442Medicare ID - Type Unspecified