Provider Demographics
NPI:1689657330
Name:MILLET, ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:
Last Name:MILLET
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:PO BOX 2513
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13089-2513
Mailing Address - Country:US
Mailing Address - Phone:315-412-9886
Mailing Address - Fax:315-944-3001
Practice Address - Street 1:7555 MORGAN RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090
Practice Address - Country:US
Practice Address - Phone:315-412-9886
Practice Address - Fax:315-944-3001
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0587631041C0700X
HI33591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02098800Medicaid
NY02098800Medicaid
NYCC0576Medicare ID - Type Unspecified