Provider Demographics
NPI:1154570059
Name:MILLER, TAMMY S (LCSW-C)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:S
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 E ANTIETAM STREET
Mailing Address - Street 2:5D
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740
Mailing Address - Country:US
Mailing Address - Phone:301-766-7600
Mailing Address - Fax:301-766-7600
Practice Address - Street 1:251 E ANTIETAM ST
Practice Address - Street 2:5D
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5724
Practice Address - Country:US
Practice Address - Phone:301-766-7600
Practice Address - Fax:301-766-7600
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD092971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD520L553COtherMEDICARE