1407071285 NPI number — MS. SUSAN HARRIET MILLER LCSWR

Table of content: MS. SUSAN HARRIET MILLER LCSWR (NPI 1407071285)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407071285 NPI number — MS. SUSAN HARRIET MILLER LCSWR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
SUSAN
Provider Middle Name:
HARRIET
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSWR
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:
1407071285
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 W 65TH ST,
Provider Second Line Business Mailing Address:
JGB MENTAL HEALTH CLINIC, 7TH FLOOR
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10023-6601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-386-9774
Provider Business Mailing Address Fax Number:
212-769-7869

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9620 CHURCH AVE
Provider Second Line Business Practice Location Address:
JGB MENTAL HEALTH CLINIC, 2ND FLOOR
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11212-2436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-386-9774
Provider Business Practice Location Address Fax Number:
718-498-9007
Provider Enumeration Date:
04/16/2007

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:  R051614-1 , 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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