MEDICARE: DR. DENISE LYNN MILES PSYD

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	017066-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A300038054	OTHER	NY	PTAN

General Provider Information

NPI Number	:	1932242583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENISE LYNN MILES PSYD

Provider Business Mailing Address
First Line	:	576 6TH AVE
Second Line	:	APT. 3
City	:	BROOKLYN
State	:	NY
Zip	:	11215-8400
Country	:	US
Telephone Number	:	718-344-2634
Fax Number	:	718-765-2574

Provider Business Practice Location Address
First Line	:	60 PLAZA ST E
Second Line	:	SUITE 1K
City	:	BROOKLYN
State	:	NY
Zip	:	11238-5025
Country	:	US
Telephone Number	:	347-316-8575
Fax Number	:

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

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	06/13/2013

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