1851808364 NPI number — MRS. SALLY BARBARA MILLER LICSW

Table of content: MRS. SALLY BARBARA MILLER LICSW (NPI 1851808364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851808364 NPI number — MRS. SALLY BARBARA MILLER LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
SALLY
Provider Middle Name:
BARBARA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
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:
1851808364
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 CABOT STREET SUITE 206
Provider Second Line Business Mailing Address:
PLAN OF MASSACHUSETTS AND RHODE ISLAND
Provider Business Mailing Address City Name:
NEEDHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02494
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-244-5552
Provider Business Mailing Address Fax Number:
617-795-0559

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 CABOT STREET SUITE 206
Provider Second Line Business Practice Location Address:
PLAN OF MASSACHUSETTS AND RHODE ISLAND
Provider Business Practice Location Address City Name:
NEEDHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02494
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-244-5552
Provider Business Practice Location Address Fax Number:
617-795-0559
Provider Enumeration Date:
01/05/2018

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:  101467 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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