Healthcare Provider Details

I. General information

NPI: 1417062480
Provider Name (Legal Business Name): RICHARD KEVIN MILLER M. ED.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 09/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 WASHINGTON RD SUITE 201
UPPER ST CLAIR PA
15241-1208
US

IV. Provider business mailing address

520 WASHINGTON RD SUITE 206
MOUNT LEBANON PA
15228-2819
US

V. Phone/Fax

Practice location:
  • Phone: 412-561-6776
  • Fax: 412-343-2130
Mailing address:
  • Phone: 412-561-6776
  • Fax: 412-343-2130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS007898L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: