Provider Demographics
NPI:1407071285
Name:MILLER, SUSAN HARRIET (LCSWR)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:HARRIET
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 W 65TH ST,
Mailing Address - Street 2:JGB MENTAL HEALTH CLINIC, 7TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-6601
Mailing Address - Country:US
Mailing Address - Phone:917-386-9774
Mailing Address - Fax:212-769-7869
Practice Address - Street 1:9620 CHURCH AVE
Practice Address - Street 2:JGB MENTAL HEALTH CLINIC, 2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-2436
Practice Address - Country:US
Practice Address - Phone:917-386-9774
Practice Address - Fax:718-498-9007
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR051614-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYSMONF45910Medicare PIN