Provider Demographics
NPI:1326589847
Name:MILLERD, LAUREN (LCSW, LICSW)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MILLERD
Suffix:
Gender:F
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 E CENTER ST
Mailing Address - Street 2:STE 255
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4484
Mailing Address - Country:US
Mailing Address - Phone:860-933-0205
Mailing Address - Fax:
Practice Address - Street 1:341 E CENTER ST STE 255
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4484
Practice Address - Country:US
Practice Address - Phone:860-796-6695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-16
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0097511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008100109Medicaid