Provider Demographics
NPI:1336273614
Name:MILLER, CAROL L (LCSW, MFT)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HOLLY LN
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-3717
Mailing Address - Country:US
Mailing Address - Phone:856-297-9627
Mailing Address - Fax:
Practice Address - Street 1:AIRPORT EXECUTIVE COMPLEX, SUITE I
Practice Address - Street 2:7 EASTERWOOD ST.
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-4816
Practice Address - Country:US
Practice Address - Phone:856-413-0266
Practice Address - Fax:856-413-0267
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051701001041C0700X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist