1053486365 NPI number — MR. WALTER LIVINGSTON MILLER LCSW LADC NCGC II

Table of content: MR. WALTER LIVINGSTON MILLER LCSW LADC NCGC II (NPI 1053486365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053486365 NPI number — MR. WALTER LIVINGSTON MILLER LCSW LADC NCGC II

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
WALTER
Provider Middle Name:
LIVINGSTON
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW LADC NCGC II
Provider Gender Code:
M

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:
1053486365
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PROBLEM GAMBLING SERVICES 2 VANCE DRIVE RUSSELL HALL
Provider Second Line Business Mailing Address:
CONNECTICUT VALLEY HOSPITAL PO BOX 351
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-344-2244
Provider Business Mailing Address Fax Number:
860-344-2360

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PROBLEM GAMBLING SERVICES 2 VANCE DRIVE RUSSELL HALL
Provider Second Line Business Practice Location Address:
CONNECTICUT VALLEY HOSPITAL
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-344-2244
Provider Business Practice Location Address Fax Number:
860-344-2360
Provider Enumeration Date:
11/21/2006

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:  000H32 , 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)





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