Healthcare Provider Details

I. General information

NPI: 1932242583
Provider Name (Legal Business Name): DENISE LYNN MILES PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 PLAZA ST E SUITE 1K
BROOKLYN NY
11238-5025
US

IV. Provider business mailing address

576 6TH AVE APT. 3
BROOKLYN NY
11215-8400
US

V. Phone/Fax

Practice location:
  • Phone: 347-316-8575
  • Fax:
Mailing address:
  • Phone: 718-344-2634
  • Fax: 718-765-2574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number017066-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: