Healthcare Provider Details

I. General information

NPI: 1861703415
Provider Name (Legal Business Name): MICHAEL G. MILLER, PH.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 ROUTE 537 E
COLTS NECK NJ
07722-2510
US

IV. Provider business mailing address

107 N HEMLOCK LN P.O. BOX 223
GREENTOWN PA
18426-0223
US

V. Phone/Fax

Practice location:
  • Phone: 908-839-7913
  • Fax:
Mailing address:
  • Phone: 908-839-7193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL GARY MILLER
Title or Position: OWNER
Credential: PH.D.
Phone: 908-839-7913