Provider Demographics
NPI:1255327672
Name:MILLER, JOAN P (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:P
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 1:399 CAMINO GARDENS BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-5828
Mailing Address - Country:US
Mailing Address - Phone:561-392-8881
Mailing Address - Fax:561-451-2822
Practice Address - Street 1:399 CAMINO GARDENS BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-5828
Practice Address - Country:US
Practice Address - Phone:561-392-8881
Practice Address - Fax:561-451-2822
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00021411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU2249Medicare ID - Type Unspecified