Provider Demographics
NPI:1477764397
Name:MILLER, KRISTIN A (LMSW-CC)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:A
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 183
Mailing Address - Street 2:
Mailing Address - City:CALAIS
Mailing Address - State:ME
Mailing Address - Zip Code:04619-0183
Mailing Address - Country:US
Mailing Address - Phone:207-454-8415
Mailing Address - Fax:
Practice Address - Street 1:10 BARKER ST
Practice Address - Street 2:
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1404
Practice Address - Country:US
Practice Address - Phone:207-454-2928
Practice Address - Fax:207-454-2747
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC111281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431745299Medicaid