Healthcare Provider Details

I. General information

NPI: 1851360325
Provider Name (Legal Business Name): DEBORAH MILLER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 E ATHERTON ST
LONG BEACH CA
90815-3700
US

IV. Provider business mailing address

4525 E ATHERTON ST
LONG BEACH CA
90815-3700
US

V. Phone/Fax

Practice location:
  • Phone: 562-961-0155
  • Fax: 562-961-0161
Mailing address:
  • Phone: 562-961-0155
  • Fax: 562-961-0161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number17792PSY
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: