Provider Demographics
NPI:1255166641
Name:MILLER, EMILY RAE TENENBAUM (LSW)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:RAE TENENBAUM
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 1:1901 LARK LN
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2918
Mailing Address - Country:US
Mailing Address - Phone:908-295-8812
Mailing Address - Fax:
Practice Address - Street 1:1901 LARK LN
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2918
Practice Address - Country:US
Practice Address - Phone:856-281-1898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06893800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker