Healthcare Provider Details

I. General information

NPI: 1255738902
Provider Name (Legal Business Name): MRS. LINDA S. MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 11/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 ERIE STREET #6 SUITE 304
GOSHEN NY
10924
US

IV. Provider business mailing address

PO BOX 609
GOSHEN NY
10924
US

V. Phone/Fax

Practice location:
  • Phone: 845-294-1882
  • Fax:
Mailing address:
  • Phone: 845-294-1882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: