Provider Demographics
NPI:1861968968
Name:MILLER, MARK JAMES (LMSW)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:JAMES
Last Name:MILLER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 N JAMES ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-2854
Mailing Address - Country:US
Mailing Address - Phone:315-336-6230
Mailing Address - Fax:315-337-9262
Practice Address - Street 1:1617 N JAMES ST STE 200
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2854
Practice Address - Country:US
Practice Address - Phone:315-336-6230
Practice Address - Fax:315-337-9262
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103575-11041C0700X
NY0963981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical