Provider Demographics
NPI:1588005854
Name:MILLER, MARIA EILEEN (MSW, LBSW)
Entity Type:Individual
Prefix:MISS
First Name:MARIA
Middle Name:EILEEN
Last Name:MILLER
Suffix:
Gender:F
Credentials:MSW, LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 S MINERVA AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-3981
Mailing Address - Country:US
Mailing Address - Phone:734-829-8950
Mailing Address - Fax:
Practice Address - Street 1:230 S MINERVA AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-3981
Practice Address - Country:US
Practice Address - Phone:734-829-8950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801072693104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker