Healthcare Provider Details

I. General information

NPI: 1831257740
Provider Name (Legal Business Name): PATRICIA POLANIK MILLER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1A PINE WEST PLZ PINE BUSH MENTAL HEALTH, LLP
ALBANY NY
12205-5556
US

IV. Provider business mailing address

1A PINE WEST PLZ PINE BUSH MENTAL HEALTH, LLP
ALBANY NY
12205-5556
US

V. Phone/Fax

Practice location:
  • Phone: 518-862-1665
  • Fax: 518-862-1668
Mailing address:
  • Phone: 518-862-1665
  • Fax: 518-862-1668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number014323
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: