Provider Demographics
NPI:1477608776
Name:MILLER, DAVINA MARION (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:DAVINA
Middle Name:MARION
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 1:57 GOTHIC ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3047
Mailing Address - Country:US
Mailing Address - Phone:413-584-1992
Mailing Address - Fax:413-584-1166
Practice Address - Street 1:57 GOTHIC ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3047
Practice Address - Country:US
Practice Address - Phone:413-584-1992
Practice Address - Fax:413-584-1166
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10154191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1857304OtherMASS HEALTH B
MA407882OtherTUFTS HEALTH CARE
MAP04729OtherBLUE CROSS AND BLUE SHIEL
MA1857304OtherMASS HEALTH B