Provider Demographics
NPI:1255492344
Name:MILLER, ANDREA J (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:J
Last Name:MILLER
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 MULBERRY STREET
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-1230
Mailing Address - Country:US
Mailing Address - Phone:812-423-7791
Mailing Address - Fax:812-422-7558
Practice Address - Street 1:410 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1231
Practice Address - Country:US
Practice Address - Phone:812-423-7791
Practice Address - Fax:812-422-7558
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN3400004809A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000328725OtherANTHEM
IN100240880Medicaid
IN11490557OtherCAQH
IN100240880Medicaid