1447494844 NPI number — KELLY M MILLER LCSW

Table of content: KELLY M MILLER LCSW (NPI 1447494844)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447494844 NPI number — KELLY M MILLER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
KELLY
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DEMPSTER
Provider Other First Name:
KELLY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447494844
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4131
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YALESVILLE
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06492-1481
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-284-1340
Provider Business Mailing Address Fax Number:
203-265-4557

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
435 LEWIS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERIDEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06451-2101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-284-1340
Provider Business Practice Location Address Fax Number:
203-265-4557
Provider Enumeration Date:
04/29/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  006446 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)