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Individual

MRS. BERNADETTE MULLINS-MILLER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
2600 N MAYFAIR RD STE 305, WAUWATOSA, WI 53226-1303
(414) 378-0999
(414) 536-8605
Mailing address
2600 N MAYFAIR RD STE 305, WAUWATOSA, WI 53226-1303
(414) 378-0999
(414) 536-8605

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
133
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
391786254014
BLUE CROSS BLUE SHIELD
WI
05
39223700
WI
01
K300159069
MEDICARE PTAN PART B
WI
01
SUFFIX B
HUMANA ID NUMBER
WI
Enumeration date
04/17/2007
Last updated
10/24/2014
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