Provider Demographics
NPI:1326487265
Name:MILLER, MARTHA E (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:E
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 1:124 E 40TH ST
Mailing Address - Street 2:SUITE 704
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-1723
Mailing Address - Country:US
Mailing Address - Phone:646-528-0396
Mailing Address - Fax:
Practice Address - Street 1:124 E 40TH ST
Practice Address - Street 2:SUITE 704
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1723
Practice Address - Country:US
Practice Address - Phone:646-528-0396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0483221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical