Provider Demographics
NPI:1609180769
Name:MILLER, SUSAN MARY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARY
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 1:1832 SCOTT RD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-3819
Mailing Address - Country:US
Mailing Address - Phone:818-568-6244
Mailing Address - Fax:
Practice Address - Street 1:1832 SCOTT RD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-3819
Practice Address - Country:US
Practice Address - Phone:818-568-6244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-31
Last Update Date:2010-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA264311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical