Healthcare Provider Details

I. General information

NPI: 1902217797
Provider Name (Legal Business Name): MELISSA MILLER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 N LEVERETT RD
LEVERETT MA
01054-9579
US

IV. Provider business mailing address

PO BOX 85
MONTAGUE MA
01351-0085
US

V. Phone/Fax

Practice location:
  • Phone: 413-345-5059
  • Fax:
Mailing address:
  • Phone: 413-345-5059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number9463
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: