Provider Demographics
NPI:1003132218
Name:MILLER, MARLENE FAYE (MA)
Entity Type:Individual
Prefix:MS
First Name:MARLENE
Middle Name:FAYE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13420 PARKER COMMONS BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-1973
Mailing Address - Country:US
Mailing Address - Phone:299-466-2000
Mailing Address - Fax:239-466-0640
Practice Address - Street 1:13420 PARKER COMMONS BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-1973
Practice Address - Country:US
Practice Address - Phone:299-466-2000
Practice Address - Fax:239-466-0640
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2467104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker