Provider Demographics
NPI:1417008822
Name:MILLER, VIRGINIA ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7481 S BROADWAY
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:RED HOOK
Mailing Address - State:NY
Mailing Address - Zip Code:12571-1780
Mailing Address - Country:US
Mailing Address - Phone:845-758-2080
Mailing Address - Fax:
Practice Address - Street 1:7481 S BROADWAY
Practice Address - Street 2:SUITE 2B
Practice Address - City:RED HOOK
Practice Address - State:NY
Practice Address - Zip Code:12571-1780
Practice Address - Country:US
Practice Address - Phone:845-758-2080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070188-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical