Provider Demographics
NPI:1558544049
Name:MILLER, THOMAS MICELLI (LCSW)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:MICELLI
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 1:57 WHEELER AVE
Mailing Address - Street 2:SUITE #208
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-3018
Mailing Address - Country:US
Mailing Address - Phone:914-523-2595
Mailing Address - Fax:914-949-6778
Practice Address - Street 1:57 WHEELER AVE
Practice Address - Street 2:SUITE #208
Practice Address - City:PLEASANTVILLE
Practice Address - State:NY
Practice Address - Zip Code:10570-3018
Practice Address - Country:US
Practice Address - Phone:914-523-2595
Practice Address - Fax:914-949-6778
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073091-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical