Provider Demographics
NPI:1568527216
Name:MILIOTIS, PAGE
Entity Type:Individual
Prefix:MS
First Name:PAGE
Middle Name:
Last Name:MILIOTIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:PAGE
Other - Middle Name:
Other - Last Name:MILIOITS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:89 W RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3142
Mailing Address - Country:US
Mailing Address - Phone:551-206-2617
Mailing Address - Fax:
Practice Address - Street 1:89 W RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3142
Practice Address - Country:US
Practice Address - Phone:551-206-2617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC048528001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical