Provider Demographics
NPI:1831782457
Name:MILLER, MONICA JOSEPHINE (MSW)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:JOSEPHINE
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 1:31818 TANGLEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48082-2255
Mailing Address - Country:US
Mailing Address - Phone:586-854-3450
Mailing Address - Fax:
Practice Address - Street 1:23100 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-2756
Practice Address - Country:US
Practice Address - Phone:586-335-2006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-15
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156F00000X
MI68511152181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No156F00000XEye and Vision Services ProvidersTechnician/Technologist