Provider Demographics
NPI:1174838668
Name:KATHLEEN MILLER, LSW, PSC
Entity Type:Organization
Organization Name:KATHLEEN MILLER, LSW, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:BRIGHID
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:814-505-4241
Mailing Address - Street 1:120 EVERGREEN LN
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16662-7059
Mailing Address - Country:US
Mailing Address - Phone:814-505-4241
Mailing Address - Fax:
Practice Address - Street 1:IDA TOWERS OFC 101012TH
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-3411
Practice Address - Country:US
Practice Address - Phone:814-505-4241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW127247251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102394936 0001OtherMA NUMBER