Provider Demographics
NPI:1386032423
Name:MILNE, MARIAH (LSW)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:MILNE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 SPRUCE CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-2707
Mailing Address - Country:US
Mailing Address - Phone:303-803-3792
Mailing Address - Fax:
Practice Address - Street 1:590 SPRUCE CIR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-2707
Practice Address - Country:US
Practice Address - Phone:303-803-3792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0009920639104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker