Provider Demographics
NPI:1407970197
Name:MILLER, BETH L (LCSW, CEC)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW, CEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 EAST MAIN STREET
Mailing Address - Street 2:DOWNSTAIRS
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777
Mailing Address - Country:US
Mailing Address - Phone:631-327-0090
Mailing Address - Fax:631-331-9202
Practice Address - Street 1:1025 NORTHERN BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1506
Practice Address - Country:US
Practice Address - Phone:516-616-3476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0703881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical