Provider Demographics
NPI:1619996162
Name:MILLER, EMILY B (MSW)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:B
Last Name:MILLER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MAYNARD ST
Mailing Address - Street 2:SUITE #503
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2440
Mailing Address - Country:US
Mailing Address - Phone:734-761-5347
Mailing Address - Fax:734-663-4327
Practice Address - Street 1:400 MAYNARD ST
Practice Address - Street 2:SUITE #503
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2440
Practice Address - Country:US
Practice Address - Phone:734-761-5347
Practice Address - Fax:734-663-4327
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010010681041C0700X
MI4101005568106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIBM810045OtherMCARE