1740527209 NPI number — CRYSTAL MARIE MILLER LCSW-C

Table of content: CRYSTAL MARIE MILLER LCSW-C (NPI 1740527209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740527209 NPI number — CRYSTAL MARIE MILLER LCSW-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
CRYSTAL
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW-C
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:
1740527209
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1118 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21804-4460
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-219-5070
Provider Business Mailing Address Fax Number:
888-796-4892

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8221 TEAL DR STE 405
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EASTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21601-7212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-219-5070
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/03/2013

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 23610 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 609500301 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 609500300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 609500303 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 609550002 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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