Provider Demographics
NPI:1477557338
Name:MILLER, ROBERT SCOTT (MSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:SCOTT
Last Name:MILLER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 SE CABOT DR
Mailing Address - Street 2:STE B206
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-3755
Mailing Address - Country:US
Mailing Address - Phone:360-240-8090
Mailing Address - Fax:360-279-2440
Practice Address - Street 1:275 SE CABOT DR
Practice Address - Street 2:STE B206
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-3755
Practice Address - Country:US
Practice Address - Phone:360-240-8090
Practice Address - Fax:360-279-2440
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000054441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALW00005444OtherSOCIAL WORK LICENSE
AB27659Medicare ID - Type Unspecified