Basic Information
| Provider Information | |||||||||
| NPI: | 1942327572 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLNER | ||||||||
| FirstName: | HELOISE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 30 MAIN ST | ||||||||
| Address2: | SUITE 503 | ||||||||
| City: | DANBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068103040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037434412 | ||||||||
| FaxNumber: | 2037443500 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 MAIN ST | ||||||||
| Address2: | SUITE 503 | ||||||||
| City: | DANBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068103040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037434412 | ||||||||
| FaxNumber: | 2037443500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 03/12/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 005658 | CT | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 005658 | CT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 008003522 | 05 | CT | MEDICAID |