Provider Demographics
NPI:1477787984
Name:MILLER, ROBERT ANDREW (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ANDREW
Last Name:MILLER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1623 E MENLO BLVD
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-2249
Mailing Address - Country:US
Mailing Address - Phone:414-967-9689
Mailing Address - Fax:414-964-2974
Practice Address - Street 1:1623 E MENLO BLVD
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-2249
Practice Address - Country:US
Practice Address - Phone:414-967-9689
Practice Address - Fax:414-964-2974
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI112123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health