Provider Demographics
NPI:1639701303
Name:MILLER, MEGAN NICOLE (MSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:NICOLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-3669
Mailing Address - Country:US
Mailing Address - Phone:831-423-9015
Mailing Address - Fax:831-423-9098
Practice Address - Street 1:119 ZINFANDEL CIR
Practice Address - Street 2:
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-3257
Practice Address - Country:US
Practice Address - Phone:831-332-8314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1375430120101YA0400X
CA1113231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA111323OtherBOARD OF BEHAVIORAL SCIENCES