Provider Demographics
NPI:1407141567
Name:MILLS, GERALDINE M (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:M
Last Name:MILLS
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:GERRY
Other - Middle Name:M
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1717 WILLIAM PENN HWY
Mailing Address - Street 2:
Mailing Address - City:MIFFLINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17059-7876
Mailing Address - Country:US
Mailing Address - Phone:717-436-8406
Mailing Address - Fax:717-436-5977
Practice Address - Street 1:1717 WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:MIFFLINTOWN
Practice Address - State:PA
Practice Address - Zip Code:17059-7876
Practice Address - Country:US
Practice Address - Phone:717-436-8406
Practice Address - Fax:717-436-5977
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW011512L101Y00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker