1609127935 NPI number — MRS. ROSEMARY THERESA MILLER LMSW

Table of content: MRS. ROSEMARY THERESA MILLER LMSW (NPI 1609127935)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609127935 NPI number — MRS. ROSEMARY THERESA MILLER LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
ROSEMARY
Provider Middle Name:
THERESA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1609127935
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 BROOKDALE PLZ
Provider Second Line Business Mailing Address:
12TH FLOOR, ROOM 1200
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11212-3139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-240-5761
Provider Business Mailing Address Fax Number:
718-240-5990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 BROOKDALE PLZ
Provider Second Line Business Practice Location Address:
12TH FLOOR, ROOM 1200
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11212-3139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-240-5761
Provider Business Practice Location Address Fax Number:
718-240-5990
Provider Enumeration Date:
09/26/2012

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: 104100000X , with the licence number:  72087004 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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