Provider Demographics
NPI:1467051466
Name:MILLER, GRACE C (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GRACE
Middle Name:C
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 1:1312 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROWNDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18421-1245
Mailing Address - Country:US
Mailing Address - Phone:570-960-1276
Mailing Address - Fax:
Practice Address - Street 1:41 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407-2357
Practice Address - Country:US
Practice Address - Phone:570-961-3361
Practice Address - Fax:570-961-3364
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0235941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical