Provider Demographics
NPI:1992004758
Name:MILLER, KATHERINE ROSE (LICSW, LADC)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:ROSE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LICSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 SUMMER ST
Mailing Address - Street 2:PO BOX 1476
Mailing Address - City:LANESBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01237-9520
Mailing Address - Country:US
Mailing Address - Phone:413-443-0018
Mailing Address - Fax:
Practice Address - Street 1:160 SUMMER ST
Practice Address - Street 2:
Practice Address - City:LANESBORO
Practice Address - State:MA
Practice Address - Zip Code:01237-9520
Practice Address - Country:US
Practice Address - Phone:413-443-0018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-19
Last Update Date:2011-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000448101YA0400X
VT089.00007891041C0700X
MA10208381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)