Provider Demographics
NPI:1083858351
Name:MILLER, MARTHA R (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:R
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:PO BOX 45
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-0045
Mailing Address - Country:US
Mailing Address - Phone:703-850-8067
Mailing Address - Fax:
Practice Address - Street 1:6723 WHITTIER AVE
Practice Address - Street 2:SUITE 406
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4522
Practice Address - Country:US
Practice Address - Phone:703-850-8067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040069881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical