Provider Demographics
NPI:1790712768
Name:MILLER, VIRGINIA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ARMISTICE BLVD
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-3233
Mailing Address - Country:US
Mailing Address - Phone:401-835-0008
Mailing Address - Fax:888-651-6430
Practice Address - Street 1:100 ARMISTICE BLVD
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-3233
Practice Address - Country:US
Practice Address - Phone:401-835-0008
Practice Address - Fax:888-651-6430
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW01381104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI62OtherUNITED HEALTHCARE
RI228804OtherBLUE CROSS BLUE SHIELD