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General NPI Number Information
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NPI Number | 1033590922
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Entity Type | Individual
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Provider Name | MICHELLE MILLER
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Gender | Female
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Dates
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Enumeration Date | 06/16/2015
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Last Update Date | 06/18/2015
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Provider Practice Location Address
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Address Line | 411 HACKENSACK AVE
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City | HACKENSACK
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State | NJ
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Zip | 07601-6328
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Country | US
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Telephone | 201-465-8111
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Fax |
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Provider Business Mailing Address
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Address Line | 23 SHORT HILLS CIR APT 1B
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City | MILLBURN
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State | NJ
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Zip | 07041-1244
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 5480
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 020985
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License Number State | NY
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