Provider Demographics
NPI:1932269206
Name:MILLER, SUSAN L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 N BEAUREGARD ST
Mailing Address - Street 2:STE 240
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-1715
Mailing Address - Country:US
Mailing Address - Phone:703-404-1936
Mailing Address - Fax:703-404-2703
Practice Address - Street 1:1500 N BEAUREGARD ST
Practice Address - Street 2:STE 240
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-1715
Practice Address - Country:US
Practice Address - Phone:703-404-1936
Practice Address - Fax:703-404-2703
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-09
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904000041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
211632OtherANTHEM
24490001OtherCAREFIRST
800001924Medicare ID - Type Unspecified