Provider Demographics
NPI:1164572020
Name:MILLER, MARJORIE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
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 1:4815 N PRESTON HWY STE 14
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-9223
Mailing Address - Country:US
Mailing Address - Phone:502-955-1009
Mailing Address - Fax:502-543-6284
Practice Address - Street 1:4815 N PRESTON HWY STE 14
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-9223
Practice Address - Country:US
Practice Address - Phone:502-955-1009
Practice Address - Fax:502-543-6284
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1394104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYPO2897Medicare UPIN
KYCSW0255Medicare ID - Type Unspecified