Provider Demographics
NPI:1578899266
Name:MILLER, MICHAEL D (LISW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:MILLER
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2955 CARL ST
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-5208
Mailing Address - Country:US
Mailing Address - Phone:330-696-5041
Mailing Address - Fax:
Practice Address - Street 1:6929 W 130TH ST
Practice Address - Street 2:SUITE 500
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-7895
Practice Address - Country:US
Practice Address - Phone:440-842-6867
Practice Address - Fax:440-842-8914
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI. 0900159104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker