Healthcare Provider Details

I. General information

NPI: 1265368690
Provider Name (Legal Business Name): ANDREI MILES PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15117 SNOW MASS CT
SILVER SPRING MD
20906-1055
US

IV. Provider business mailing address

15117 SNOW MASS CT
SILVER SPRING MD
20906-1055
US

V. Phone/Fax

Practice location:
  • Phone: 646-942-0342
  • Fax:
Mailing address:
  • Phone: 646-942-0342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN VERMUT
Title or Position: PRACTICE MANAGER
Credential:
Phone: 646-942-0342