Provider Demographics
NPI:1235407883
Name:GILLER, MIRIAM GRACE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:GRACE
Last Name:GILLER
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 1:2008 FERGUSON ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12303-4125
Mailing Address - Country:US
Mailing Address - Phone:518-356-0113
Mailing Address - Fax:
Practice Address - Street 1:2008 FERGUSON ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-4125
Practice Address - Country:US
Practice Address - Phone:518-356-0113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073386-11041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool