Healthcare Provider Details

I. General information

NPI: 1619704079
Provider Name (Legal Business Name): TERENSA MILLER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 DYRE AVE
BRONX NY
10466-2510
US

IV. Provider business mailing address

164 PALISADE AVE
YONKERS NY
10701-2905
US

V. Phone/Fax

Practice location:
  • Phone: 718-515-3000
  • Fax:
Mailing address:
  • Phone: 914-525-4126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: