Healthcare Provider Details

I. General information

NPI: 1033421193
Provider Name (Legal Business Name): LIV E MILLER PSYD, ABPP-CN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 CHESTNUT RIDGE RD
MORGANTOWN WV
26505-2807
US

IV. Provider business mailing address

930 CHESTNUT RIDGE RD
MORGANTOWN WV
26505-2807
US

V. Phone/Fax

Practice location:
  • Phone: 501-257-1667
  • Fax:
Mailing address:
  • Phone: 304-293-5227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number10-21P
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: