Provider Demographics
NPI:1093870495
Name:MILLER, JULIE ANN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1272 W MAIN RD
Mailing Address - Street 2:BUILDING I
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842
Mailing Address - Country:US
Mailing Address - Phone:401-619-1634
Mailing Address - Fax:401-619-1634
Practice Address - Street 1:1272 W MAIN RD
Practice Address - Street 2:BUILDING I
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842
Practice Address - Country:US
Practice Address - Phone:401-619-1634
Practice Address - Fax:401-619-1634
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW012971041C0700X
MA1100021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical