Provider Demographics
NPI:1629012505
Name:MILLER, KAREN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LICSW
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 784
Mailing Address - Street 2:
Mailing Address - City:HOUSATONIC
Mailing Address - State:MA
Mailing Address - Zip Code:01236-0784
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:213 SOUTH STREET
Practice Address - Street 2:
Practice Address - City:HOUSATONIC
Practice Address - State:MA
Practice Address - Zip Code:01236-0784
Practice Address - Country:US
Practice Address - Phone:413-274-1112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110230104100000X
PASW009158L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
2081087OtherCIGNA
1892959OtherMASS HEALTH
P07703OtherBCBS
359216OtherMAGELLAN
61240OtherMVP
87726OtherUBH