Provider Demographics
NPI:1023263878
Name:MILLER, RONALD F SR (LADC)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:F
Last Name:MILLER
Suffix:SR
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 ELM ST STE B
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-1424
Mailing Address - Country:US
Mailing Address - Phone:207-725-7592
Mailing Address - Fax:207-725-7593
Practice Address - Street 1:63 ELM ST STE B
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1424
Practice Address - Country:US
Practice Address - Phone:207-725-7592
Practice Address - Fax:207-725-7593
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC4013101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME102140100Medicaid