Provider Demographics
NPI:1578662300
Name:MILLER, GAIL A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:A
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 STONY BROOK RD
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08525-2806
Mailing Address - Country:US
Mailing Address - Phone:609-466-4246
Mailing Address - Fax:609-466-7406
Practice Address - Street 1:11 CHARLTON ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540
Practice Address - Country:US
Practice Address - Phone:609-466-4246
Practice Address - Fax:609-466-7406
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001569001041C0700X
PACW004216L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ002310801Medicaid
NJ650417Medicare ID - Type Unspecified
NJ002310801Medicaid