Provider Demographics
NPI:1235369323
Name:ROBERT S MILLER, LICSW, ACSW, PLLC
Entity Type:Organization
Organization Name:ROBERT S MILLER, LICSW, ACSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:360-632-5267
Mailing Address - Street 1:275 SE CABOT DR
Mailing Address - Street 2:SUITE B206
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-3715
Mailing Address - Country:US
Mailing Address - Phone:360-632-5267
Mailing Address - Fax:866-885-5921
Practice Address - Street 1:275 SE CABOT DR
Practice Address - Street 2:SUITE B206
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-3715
Practice Address - Country:US
Practice Address - Phone:360-632-5267
Practice Address - Fax:866-885-5921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000054441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB27659Medicare PIN