Provider Demographics
NPI:1245422716
Name:MILLER, JOSEPH LEON JR (LISW)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LEON
Last Name:MILLER
Suffix:JR
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8338 COMANCHE RD NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-2304
Mailing Address - Country:US
Mailing Address - Phone:505-323-3665
Mailing Address - Fax:505-323-1038
Practice Address - Street 1:8338 COMANCHE RD NE
Practice Address - Street 2:SUITE B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-2304
Practice Address - Country:US
Practice Address - Phone:505-323-3665
Practice Address - Fax:505-323-1038
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-050161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM600516OtherVALUE OPTIONS NM
NM76804OtherPRESBYTERIAN HEALTH PLAN
NM34083260Medicaid
NM10006701OtherLOVELACE HEALTH PLAN
NMNM00JB93OtherBLUE CROSS BLUE SHIELD NM