=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740553130
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTIAN ROBERT MINER PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2012
-----------------------------------------------------
Last Update Date | 03/05/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 116 STEEP HILL RD
-----------------------------------------------------
City | WESTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06883-1824
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-848-7473
-----------------------------------------------------
Fax | 203-557-8100
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 116 STEEP HILL RD
-----------------------------------------------------
City | WESTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06883-1824
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-848-7473
-----------------------------------------------------
Fax | 203-557-8100
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 008435
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 003685
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------