Provider Demographics
NPI:1508087750
Name:MILLER, MARY E (LISW-S)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:E
Last Name:MILLER
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:RUFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:600 WEST THIRD STREET
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-2633
Mailing Address - Country:US
Mailing Address - Phone:419-522-6191
Mailing Address - Fax:419-526-4911
Practice Address - Street 1:600 WEST THIRD STREET
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-2633
Practice Address - Country:US
Practice Address - Phone:419-522-6191
Practice Address - Fax:419-526-4911
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.07002731041C0700X
OH1.07002731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical