Elisa Jacqueline Miller

Key facts

NPI

1306522305

Entity type

Individual (NPI type 1)

Primary specialty

Clinical Social Worker 1041C0700X

License

ACSW115817 (CA)

Practice address

2460 Sonnenfelt Rd
Bayside, CA 95524-9308

Phone

(170) 722-3980

NPI assigned

Jun 23, 2023

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 23, 2023.

{
    "created_epoch": "1687478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687478400000",
    "number": "1306522305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2460 SONNENFELT RD",
            "city": "BAYSIDE",
            "state": "CA",
            "postal_code": "955249308",
            "telephone_number": "170-722-3980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2460 SONNENFELT RD",
            "city": "BAYSIDE",
            "state": "CA",
            "postal_code": "955249308",
            "telephone_number": "170-722-3980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "ELISA",
        "middle_name": "JACQUELINE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-06-23",
        "last_updated": "2023-06-23",
        "certification_date": "2023-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "ACSW115817",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Bayside, CA · Clinical Social Worker in California