Provider Demographics
NPI:1679337695
Name:MILROY, SERENA (MSW, LSWAIC)
Entity type:Individual
Prefix:
First Name:SERENA
Middle Name:
Last Name:MILROY
Suffix:
Gender:F
Credentials:MSW, LSWAIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:HANSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98340-0130
Mailing Address - Country:US
Mailing Address - Phone:510-457-6491
Mailing Address - Fax:
Practice Address - Street 1:7627 BRUCE LN
Practice Address - Street 2:
Practice Address - City:HANSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98340
Practice Address - Country:US
Practice Address - Phone:510-457-6491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61520911103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty