Provider Demographics
NPI:1134670805
Name:MILLER, LAURA JA (LMSW/CASAC)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:JA
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMSW/CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 COURT ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-4236
Mailing Address - Country:US
Mailing Address - Phone:315-507-5800
Mailing Address - Fax:315-507-5802
Practice Address - Street 1:502 COURT ST
Practice Address - Street 2:SUITE 210
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-4236
Practice Address - Country:US
Practice Address - Phone:315-507-5800
Practice Address - Fax:315-507-5802
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21147101YA0400X
NY094827104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)