Healthcare Provider Details

I. General information

NPI: 1942610258
Provider Name (Legal Business Name): STEPHANIE MILLER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2014
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W 9TH AVE UNIT 2115
DENVER CO
80204-4045
US

IV. Provider business mailing address

150 W 9TH AVE UNIT 2115
DENVER CO
80204-4045
US

V. Phone/Fax

Practice location:
  • Phone: 516-672-2243
  • Fax:
Mailing address:
  • Phone: 516-672-2243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number4316
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: