1750768602 NPI number — MS. NICOLE B MILLER LMSW

Table of content: (NPI 1194436428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750768602 NPI number — MS. NICOLE B MILLER LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
NICOLE
Provider Middle Name:
B
Provider Name Prefix Text:
MS.
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:
1750768602
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6339 MILL STREET
Provider Second Line Business Mailing Address:
P.O. BOX 5005
Provider Business Mailing Address City Name:
RHIWEBOCK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12572
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-871-1000
Provider Business Mailing Address Fax Number:
845-876-2020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1419 SHAKESPEARE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10452-1800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-732-7080
Provider Business Practice Location Address Fax Number:
718-732-7090
Provider Enumeration Date:
04/29/2015

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:  098206 , 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)

  • Identifier: 098206 . This is a "NYS LICENSEE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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