Provider Demographics
NPI:1699840447
Name:CEREOLA MILLER, JOSEPHINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JOSEPHINE
Middle Name:
Last Name:CEREOLA MILLER
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 1:276 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3543
Mailing Address - Country:US
Mailing Address - Phone:632-189-5305
Mailing Address - Fax:631-289-5305
Practice Address - Street 1:276 WEST AVE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3543
Practice Address - Country:US
Practice Address - Phone:632-189-5305
Practice Address - Fax:631-289-5305
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR022374 1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health