Tracy Ann Miller, LCSW

Key facts

NPI

1154424422

Entity type

Individual (NPI type 1)

Primary specialty

Clinical Social Worker 1041C0700X

License

074860-1 (NY)

Practice address

960 West Maple Court
Elma, NY 14059

Phone

(716) 805-1555

Fax

(716) 805-1444

NPI assigned

Sep 5, 2006

Sex

Female

Sole proprietor

No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• State of New York Comptrollers Office Developmental Disabilities Clinic/Center · Staten Island, NY · NPI 1750469912
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1157414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1154424422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "172 PARK ST",
            "city": "ARCADE",
            "state": "NY",
            "postal_code": "140091502",
            "telephone_number": "585-492-0189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "960 WEST MAPLE COURT",
            "city": "ELMA",
            "state": "NY",
            "postal_code": "14059",
            "telephone_number": "716-805-1555",
            "fax_number": "716-805-1444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "TRACY",
        "middle_name": "ANN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "074860-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Elma, NY · Clinical Social Worker in New York