MEDICARE: DR. CAROLE L. KUNKLE-MILLER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PS004214L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	081894	OTHER	PA	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1588704944	OTHER	PA	NPI
3	1417062480	OTHER	PA	NPI
4	1619196987	OTHER	PA	GROUP NPI
5	630614	OTHER	PA	BLUE CROSS GROUP
6	1336286772	OTHER	PA	NPI JA
7	1457375784	OTHER	PA	NPI
8	1485089	OTHER	PA	BLUE SHIELD
9	139591	OTHER	PA	BLUE CROSS

General Provider Information

NPI Number	:	1649386228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLE L. KUNKLE-MILLER PH.D.

Provider Business Mailing Address
First Line	:	1720 WASHINGTON RD
Second Line	:	SUITE 208
City	:	PITTSBURGH
State	:	PA
Zip	:	15241-1208
Country	:	US
Telephone Number	:	412-854-4887
Fax Number	:	412-386-3733

Provider Business Practice Location Address
First Line	:	1720 WASHINGTON RD
Second Line	:	SUITE 208
City	:	PITTSBURGH
State	:	PA
Zip	:	15241-1208
Country	:	US
Telephone Number	:	412-854-4887
Fax Number	:	412-386-3733

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	01/09/2014

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Directions to “ DR. CAROLE L. KUNKLE-MILLER PH.D.” Practice Location

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