Provider Demographics
NPI:1689937286
Name:MILLER, KARIN L (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8437 SE 62 ST.
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040
Mailing Address - Country:US
Mailing Address - Phone:206-915-6682
Mailing Address - Fax:
Practice Address - Street 1:9725 SE. 36 ST. #301
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040
Practice Address - Country:US
Practice Address - Phone:206-915-6682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00004019104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker