Provider Demographics
NPI:1750451084
Name:MILLER, BARBARA JANE (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:JANE
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 1:14 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01966-2132
Mailing Address - Country:US
Mailing Address - Phone:978-546-1615
Mailing Address - Fax:
Practice Address - Street 1:14 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:MA
Practice Address - Zip Code:01966-2132
Practice Address - Country:US
Practice Address - Phone:978-546-1615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMASWLICSW 1055421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
070512OtherVALUE OPTIONS
P06855OtherBCBS,PPO,HMO
MA1854470Medicaid
MA101075000OtherMAGELLAN
MAMIP06855Medicare ID - Type Unspecified