Provider Demographics
NPI:1083839609
Name:MULLINS-MILLER, BERNADETTE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BERNADETTE
Middle Name:
Last Name:MULLINS-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 1:2600 N MAYFAIR RD STE 305
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1303
Mailing Address - Country:US
Mailing Address - Phone:414-378-0999
Mailing Address - Fax:414-536-8605
Practice Address - Street 1:2600 N MAYFAIR RD STE 305
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1303
Practice Address - Country:US
Practice Address - Phone:414-378-0999
Practice Address - Fax:414-536-8605
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK300159069OtherMEDICARE PTAN PART B
WISUFFIX BOtherHUMANA ID NUMBER
WI391786254014OtherBLUE CROSS BLUE SHIELD
WI39223700Medicaid
WISUFFIX BOtherHUMANA ID NUMBER