Provider Demographics
NPI:1245815331
Name:MILLER, SAMANTHA LEE (LSW)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LEE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CENTER GROVE RD APT 9-1
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-4436
Mailing Address - Country:US
Mailing Address - Phone:908-566-6713
Mailing Address - Fax:
Practice Address - Street 1:100 CENTER GROVE RD APT 9-1
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-4436
Practice Address - Country:US
Practice Address - Phone:908-566-6713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06598600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker