Provider Demographics
NPI:1215379979
Name:MILLER, ANTHONY JEROME (MS)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JEROME
Last Name:MILLER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 WESTHALL LN
Mailing Address - Street 2:207
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7203
Mailing Address - Country:US
Mailing Address - Phone:407-312-3155
Mailing Address - Fax:
Practice Address - Street 1:5168 LOMA VISTA CIR
Practice Address - Street 2:APT. 206
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6680
Practice Address - Country:US
Practice Address - Phone:407-312-3155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker