Provider Demographics
NPI:1407107683
Name:MILLER, KRISTY MARIE (SWT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:SWT
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:MARIE
Other - Last Name:SHEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2546 KENILWORTH RD APT 23
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44106-2475
Mailing Address - Country:US
Mailing Address - Phone:812-201-0245
Mailing Address - Fax:
Practice Address - Street 1:22001 FAIRMOUNT BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44118-4819
Practice Address - Country:US
Practice Address - Phone:216-932-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1200192-TRNE1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool