Provider Demographics
NPI:1578110169
Name:MILLER, LEANNE
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:759 CHIEF JUSTICE CUSHING HWY STE 303
Mailing Address - Street 2:
Mailing Address - City:COHASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02025-2115
Mailing Address - Country:US
Mailing Address - Phone:262-215-0189
Mailing Address - Fax:
Practice Address - Street 1:6 ANN VINAL RD
Practice Address - Street 2:
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066-2017
Practice Address - Country:US
Practice Address - Phone:262-215-0189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2230261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical