Healthcare Provider Details

I. General information

NPI: 1427279074
Provider Name (Legal Business Name): SUSAN S MILLER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5105 SEVILLA AVE NW
ALBUQUERQUE NM
87120-1831
US

IV. Provider business mailing address

5105 SEVILLA AVE NW
ALBUQUERQUE NM
87120-1831
US

V. Phone/Fax

Practice location:
  • Phone: 505-515-5397
  • Fax:
Mailing address:
  • Phone: 505-515-5397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1033
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY19995
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: