Basic Information
| Provider Information | |||||||||
| NPI: | 1386080406 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 95000 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191954655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004446020 | ||||||||
| FaxNumber: | 8452561881 | ||||||||
| Practice Location | |||||||||
| Address1: | 279 MAIN ST | ||||||||
| Address2: | 102 | ||||||||
| City: | NEW PALTZ | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125611623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452552930 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2013 | ||||||||
| LastUpdateDate: | 01/13/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 088504 | NY | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 0849201 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.