Provider Demographics
NPI:1467624304
Name:MILLER, LAURA WENRICH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:WENRICH
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 1:1455 CANAL CROSS CT
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32766-5094
Mailing Address - Country:US
Mailing Address - Phone:717-682-0577
Mailing Address - Fax:
Practice Address - Street 1:3586 ALOMA AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4010
Practice Address - Country:US
Practice Address - Phone:407-906-5115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0161981041C0700X
FLSW121431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical