Provider Demographics
NPI:1477611317
Name:ZILLER, MARY P (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:P
Last Name:ZILLER
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 1:365 BUENA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-1620
Mailing Address - Country:US
Mailing Address - Phone:203-394-7189
Mailing Address - Fax:203-330-0896
Practice Address - Street 1:365 BUENA VISTA RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-1620
Practice Address - Country:US
Practice Address - Phone:203-394-7189
Practice Address - Fax:203-330-0896
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0029051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical