Provider Demographics
NPI:1407185457
Name:MILLER, CHRISTINA (M ED, MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:M ED, MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 MERRIMACK ST
Mailing Address - Street 2:ENTRANCE H, SUITE 120
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1514
Mailing Address - Country:US
Mailing Address - Phone:781-839-9571
Mailing Address - Fax:
Practice Address - Street 1:360 MERRIMACK ST
Practice Address - Street 2:ENTRANCE H, SUITE 120
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843
Practice Address - Country:US
Practice Address - Phone:781-839-9571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-21
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2234361041C0700X
MA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical