Healthcare Provider Details

I. General information

NPI: 1275740680
Provider Name (Legal Business Name): ROBERT F MILLER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1196 KENSINGTON RD NE
CARROLLTON OH
44615-9763
US

IV. Provider business mailing address

1191 CHASE RD SE
CARROLLTON OH
44615-9619
US

V. Phone/Fax

Practice location:
  • Phone: 330-575-5364
  • Fax: 330-627-4076
Mailing address:
  • Phone: 330-575-5364
  • Fax: 330-627-4076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE-1959
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6424
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS. 0017766
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: