Provider Demographics
NPI:1396864435
Name:MILLER, GARY M (MSW, LSW)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:M
Last Name:MILLER
Suffix:
Gender:M
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 CHRISTIANA MDWS
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-2863
Mailing Address - Country:US
Mailing Address - Phone:302-325-2169
Mailing Address - Fax:215-849-0500
Practice Address - Street 1:211 N MONROE ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3019
Practice Address - Country:US
Practice Address - Phone:302-325-2169
Practice Address - Fax:215-849-0500
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW000982E1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical