Provider Demographics
NPI:1467502351
Name:MILLER, JANELLE ANNE (MSW, LICSW)
Entity Type:Individual
Prefix:MRS
First Name:JANELLE
Middle Name:ANNE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 MAIN ST STE 10
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-0606
Mailing Address - Country:US
Mailing Address - Phone:781-996-4365
Mailing Address - Fax:
Practice Address - Street 1:751 MAIN ST STE 10
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-0606
Practice Address - Country:US
Practice Address - Phone:781-996-4365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1145261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical