Healthcare Provider Details

I. General information

NPI: 1699930131
Provider Name (Legal Business Name): ANITA MILLER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANITA KEENER PH.D

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 BELMONT AVE
SCHENECTADY NY
12308-2104
US

IV. Provider business mailing address

PO BOX 685
CAROGA LAKE NY
12032-0685
US

V. Phone/Fax

Practice location:
  • Phone: 518-382-4522
  • Fax:
Mailing address:
  • Phone: 518-835-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number015367
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: