Healthcare Provider Details

I. General information

NPI: 1700091972
Provider Name (Legal Business Name): MICHAEL VINCENT MILLER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14A ELIOT ST THIRD FLOOR
CAMBRIDGE MA
02138-5706
US

IV. Provider business mailing address

254 W 15TH ST SUITE 3C
NEW YORK NY
10011-6544
US

V. Phone/Fax

Practice location:
  • Phone: 617-818-7002
  • Fax:
Mailing address:
  • Phone: 212-255-9125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number1764
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: