Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | LCS-8741 | CA |
NPI | 1003089996 |
---|---|
Provider Name | Shirley J. Miller |
First Address | Placerville, CA 95667-4200 |
Second Address | Placerville, CA 95667-4200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2008 |
Last Update Date | 11/04/2008 |