MEDICARE: AMY MILLER

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1699805804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY MILLER

Provider Business Mailing Address
First Line	:	277 22ND ST APT 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-6531
Country	:	US
Telephone Number	:	718-667-2679
Fax Number	:

Provider Business Practice Location Address
First Line	:	777 SEAVIEW AVE # 2
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-3409
Country	:	US
Telephone Number	:	718-667-2679
Fax Number	:

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	09/30/2010

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