1770267767 NPI number — MS. MARIE ROMAINE MILLER M.A., LMSW, DE-CMHS

Table of content: MS. MARIE ROMAINE MILLER M.A., LMSW, DE-CMHS (NPI 1770267767)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770267767 NPI number — MS. MARIE ROMAINE MILLER M.A., LMSW, DE-CMHS

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
MILLER

Provider First Name:
MARIE

Provider Middle Name:
ROMAINE

Provider Name Prefix Text:
MS.

Provider Name Suffix Text:

Provider Credential Text:
M.A., LMSW, DE-CMHS

Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:
MILLER

Provider Other First Name:
MARIE

Provider Other Middle Name:
ROMAINE

Provider Other Name Prefix Text:
MS.

Provider Other Name Suffix Text:

Provider Other Credential Text:
M.M., LMSW,DE-CMHS

Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1770267767

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
06/12/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 334

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:
GREENWOOD

Provider Business Mailing Address State Name:
DE

Provider Business Mailing Address Postal Code:
19950-0334

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
201-686-1182

Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
206 SEACHASE LN

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:
GREENWOOD

Provider Business Practice Location Address State Name:
DE

Provider Business Practice Location Address Postal Code:
19950-4021

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
201-686-1182

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:
06/12/2023

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: Q3-0010865 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .