Provider Demographics
NPI:1720044704
Name:MILLER, PATRICIA J (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name: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 1:6230 NW BARRY RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64154-2530
Mailing Address - Country:US
Mailing Address - Phone:816-505-3311
Mailing Address - Fax:816-505-3511
Practice Address - Street 1:6230 NW BARRY RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64154-2530
Practice Address - Country:US
Practice Address - Phone:816-505-3311
Practice Address - Fax:816-505-3511
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010283801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO35558015OtherBLUE SHIELD KANSAS CITY