Provider Demographics
NPI:1336424043
Name:MILLER, MONICA A (MA)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:A
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:ANN
Other - Last Name:DE MAIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:3505 DEPEW CIRCLE
Mailing Address - Street 2:LIFE TRANSITIONS, INC.
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952
Mailing Address - Country:US
Mailing Address - Phone:941-627-2100
Mailing Address - Fax:941-627-6442
Practice Address - Street 1:3505 DEPEW CIRCLE
Practice Address - Street 2:LIFE TRANSITIONS, INC.
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952
Practice Address - Country:US
Practice Address - Phone:941-627-2100
Practice Address - Fax:941-627-6442
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMHC-IMH 6204101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health