Provider Demographics
NPI:1093003774
Name:MILLER, KATHERINE COMINGORE (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:COMINGORE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ANN
Other - Last Name:COMINGORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2055 ANDERSON RD
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-1210
Mailing Address - Country:US
Mailing Address - Phone:530-219-3422
Mailing Address - Fax:
Practice Address - Street 1:2055 ANDERSON RD
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-1210
Practice Address - Country:US
Practice Address - Phone:530-219-3422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical