Provider Demographics
NPI:1598845463
Name:MILLER, DEBRA-ANN W (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBRA-ANN
Middle Name:W
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:PO BOX 323
Mailing Address - Street 2:160 PUBLIC LANDING ROAD
Mailing Address - City:SPRINGFIELD CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:13468-0323
Mailing Address - Country:US
Mailing Address - Phone:315-868-4866
Mailing Address - Fax:
Practice Address - Street 1:160 PUBLIC LANDING ROAD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD CENTER
Practice Address - State:NY
Practice Address - Zip Code:13468-0323
Practice Address - Country:US
Practice Address - Phone:315-868-4866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071549-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical