Provider Demographics
NPI:1730336207
Name:MILLER, REBECCA DAWN (LPC, ATR-BC, ATCS)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:DAWN
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPC, ATR-BC, ATCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 ORCHARD GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3730
Mailing Address - Country:US
Mailing Address - Phone:917-817-6573
Mailing Address - Fax:917-817-6573
Practice Address - Street 1:1624 ORCHARD GROVE AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3730
Practice Address - Country:US
Practice Address - Phone:917-817-6573
Practice Address - Fax:917-817-6573
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2305049101YM0800X
NY001176221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00801276Medicaid