Active NPI
Mandy R Miller, LCSW
- Clinical Social Worker
- Riverside, CA
National Provider Identifier
1255598264
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCS 27136
- Practice address
- 769 W Blaine St
Suite B
Riverside, CA 92507-3970 - Phone
- (951) 358-4705
- Fax
- (951) 358-4719
- NPI assigned
- May 19, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCS 27136 | CA | Primary |
Addresses
Primary practice location
769 W Blaine St
Suite B
Riverside, CA 92507-3970
Mailing address
25828 Redlands Blvd
Redlands, CA 92373-8449
Phone (909) 825-7084
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCS 27136 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666137600000",
"number": "1255598264",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25828 REDLANDS BLVD",
"city": "REDLANDS",
"state": "CA",
"postal_code": "923738449",
"telephone_number": "909-825-7084",
"fax_number": "951-358-4719"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "769 W BLAINE ST",
"address_2": "SUITE B",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925073970",
"telephone_number": "951-358-4705",
"fax_number": "951-358-4719"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "MANDY",
"middle_name": "R",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-05-19",
"last_updated": "2022-10-19",
"certification_date": "2022-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCS 27136",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.