Provider Demographics
NPI:1164433421
Name:MILLER, RICHARD C (LICSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:C
Last Name:MILLER
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 IPSWICH ST
Mailing Address - Street 2:#108
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:617-437-6303
Mailing Address - Fax:508-487-8983
Practice Address - Street 1:30 IPSWICH ST
Practice Address - Street 2:#108
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-437-6303
Practice Address - Fax:508-487-8983
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1076951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
420161OtherHPHC
713890OtherTUFTS
P04490OtherBCBS
P04490OtherBCBS