Provider Demographics
NPI:1043495195
Name:MILLER, ELEONORA (LCSW)
Entity Type:Individual
Prefix:
First Name:ELEONORA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:988 NEW LONDON TPKE
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-5312
Mailing Address - Country:US
Mailing Address - Phone:860-262-4125
Mailing Address - Fax:
Practice Address - Street 1:1844 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06517-1400
Practice Address - Country:US
Practice Address - Phone:203-407-1310
Practice Address - Fax:203-407-1309
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0078381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008003745Medicaid
CT008057039Medicaid
CT004041000Medicaid
CT008003745Medicaid
CT008057039Medicaid