Provider Demographics
NPI:1619267440
Name:MILEY, MARY ELIZABETH (MSW, LCSW, CSSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELIZABETH
Last Name:MILEY
Suffix:
Gender:F
Credentials:MSW, LCSW, CSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 VINE ST
Mailing Address - Street 2:92 VINE STREET
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-1433
Mailing Address - Country:US
Mailing Address - Phone:860-229-4830
Mailing Address - Fax:860-826-8701
Practice Address - Street 1:92 VINE ST
Practice Address - Street 2:92 VINE STREET
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1433
Practice Address - Country:US
Practice Address - Phone:860-229-4830
Practice Address - Fax:860-826-8701
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0069591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical