1619267440 NPI number — MS. MARY ELIZABETH MILEY MSW, LCSW, CSSW

Table of content: MS. MARY ELIZABETH MILEY MSW, LCSW, CSSW (NPI 1619267440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619267440 NPI number — MS. MARY ELIZABETH MILEY MSW, LCSW, CSSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILEY
Provider First Name:
MARY
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW, CSSW
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:
1619267440
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
92 VINE ST
Provider Second Line Business Mailing Address:
92 VINE STREET
Provider Business Mailing Address City Name:
NEW BRITAIN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06052-1433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-229-4830
Provider Business Mailing Address Fax Number:
860-826-8701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
92 VINE ST
Provider Second Line Business Practice Location Address:
92 VINE STREET
Provider Business Practice Location Address City Name:
NEW BRITAIN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06052-1433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-229-4830
Provider Business Practice Location Address Fax Number:
860-826-8701
Provider Enumeration Date:
04/13/2011

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:  006959 , 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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