Provider Demographics
NPI:1548562770
Name:MILES, SHARON JEAN (LMSW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:JEAN
Last Name:MILES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 VISTA GRANDE DR NW UNIT 10
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1040
Mailing Address - Country:US
Mailing Address - Phone:505-836-5794
Mailing Address - Fax:505-836-2254
Practice Address - Street 1:2700 VISTA GRANDE DR NW UNIT 10
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1040
Practice Address - Country:US
Practice Address - Phone:505-836-5794
Practice Address - Fax:505-836-2254
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-2217104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker