Provider Demographics
NPI:1659743219
Name:MILES, TYRONE MARSHALL JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:TYRONE
Middle Name:MARSHALL
Last Name:MILES
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1147 LANGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-2817
Mailing Address - Country:US
Mailing Address - Phone:609-417-0825
Mailing Address - Fax:
Practice Address - Street 1:1147 LANGHAM AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-2817
Practice Address - Country:US
Practice Address - Phone:609-417-0825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-22
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL061107001041C0700X
NJ44SC058024001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical