=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366492308
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN MILLER L.M.F.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 601 SUMMIT AVE
-----------------------------------------------------
City | JENKINTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19046-3238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-593-5655
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8360 FAIRVIEW RD
-----------------------------------------------------
City | ELKINS PARK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19027-2121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-635-6596
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MF000188
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------