Active NPI
Mary Michele Miller, LCSW
- Clinical Social Worker
- Van Nuys, CA
National Provider Identifier
1730472093
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 17303
- Practice address
- 6651 Balboa Blvd
Van Nuys, CA 91406-5529 - Phone
- (818) 997-2640
- NPI assigned
- May 19, 2011
- 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 | 17303 | CA | Primary |
Addresses
Primary practice location
6651 Balboa Blvd
Van Nuys, CA 91406-5529
Mailing address
6651 Balboa Blvd
Van Nuys, CA 91406-5529
Phone (818) 997-2640
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 |
|---|---|---|---|
| 17303 | CA | MD | Sports Physician Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1305763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1378771200000",
"number": "1730472093",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6651 BALBOA BLVD",
"city": "VAN NUYS",
"state": "CA",
"postal_code": "914065529",
"telephone_number": "818-997-2640"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6651 BALBOA BLVD",
"city": "VAN NUYS",
"state": "CA",
"postal_code": "914065529",
"telephone_number": "818-997-2640"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "MARY",
"middle_name": "MICHELE",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-05-19",
"last_updated": "2013-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "17303",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Van Nuys, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.