Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | SW5621 | FL |
NPI | 1003133950 |
---|---|
Provider Name | Carol Lynne Miller |
First Address | Jacksonville, FL 32225-1666 |
Second Address | Jacksonville, FL 32225-1666 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2010 |
Last Update Date | 03/11/2014 |