Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 52209 | TX |
NPI | 1003272295 |
---|---|
Provider Name | Melissa D Miller |
First Address | San Antonio, TX 78229-3901 |
Second Address | San Antonio, TX 78229-4001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2016 |
Last Update Date | 23/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
353733401 | (05) | TX |