MEDICARE: DR. MARC CRAIG 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	PSY15728	CA
2	103T00000X	Psychologist	PSY15728	CA

General Provider Information

NPI Number	:	1902908650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC CRAIG MILLER PH.D.

Provider Business Mailing Address
First Line	:	1760 SOLANO AVE
Second Line	:	# 200
City	:	BERKELEY
State	:	CA
Zip	:	94707-2218
Country	:	US
Telephone Number	:	510-528-4441
Fax Number	:	510-849-1064

Provider Business Practice Location Address
First Line	:	1760 SOLANO AVE
Second Line	:	# 200
City	:	BERKELEY
State	:	CA
Zip	:	94707-2218
Country	:	US
Telephone Number	:	510-528-4441
Fax Number	:	510-849-1064

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

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	09/11/2025

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