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General NPI Number Information
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NPI Number | 1073684882
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Entity Type | Individual
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Provider Name | ELYSE AMY MILLER LCAT
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Gender | Female
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1000 PARK BLVD UNIT F
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City | MASSAPEQUA PARK
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State | NY
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Zip | 11762-2740
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Country | US
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Telephone | 516-984-2712
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Fax |
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Provider Business Mailing Address
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Address Line | 22 WAGON LN
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City | LEVITTOWN
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State | NY
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Zip | 11756-4112
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Country | US
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Telephone | 516-735-8891
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 000021
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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License Number | 000021-1
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License Number State | NY
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