Provider Demographics
NPI:1265553952
Name:MILLER, LAVERNE BEAL (MED)
Entity type:Individual
Prefix:MRS
First Name:LAVERNE
Middle Name:BEAL
Last Name:MILLER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4951 22ND ST NE
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34120-0405
Mailing Address - Country:US
Mailing Address - Phone:239-657-4434
Mailing Address - Fax:239-657-4331
Practice Address - Street 1:425 N 1ST ST
Practice Address - Street 2:
Practice Address - City:IMMOKALEE
Practice Address - State:FL
Practice Address - Zip Code:34142-3150
Practice Address - Country:US
Practice Address - Phone:239-657-4434
Practice Address - Fax:239-657-4331
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health