Provider Demographics
NPI:1013608785
Name:MILLER, ALYSSA BROOKE (MSW, LISW)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:BROOKE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 BECKLEY FARM WAY
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-9483
Mailing Address - Country:US
Mailing Address - Phone:937-479-5707
Mailing Address - Fax:
Practice Address - Street 1:825 HART ROAD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-8699
Practice Address - Country:US
Practice Address - Phone:513-934-5899
Practice Address - Fax:513-934-2466
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.22041121041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical