Provider Demographics
NPI:1225190119
Name:MILLER, MARJORIE L (LCSW)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:L
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 1:715 N. TWELFTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:FL
Mailing Address - Zip Code:34266
Mailing Address - Country:US
Mailing Address - Phone:863-434-1242
Mailing Address - Fax:863-431-0466
Practice Address - Street 1:715 N. TWELFTH AVENUE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266
Practice Address - Country:US
Practice Address - Phone:863-434-1242
Practice Address - Fax:863-431-0466
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW7248104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker