Provider Demographics
NPI:1053319947
Name:MILLER, KIM PATRICIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:PATRICIA
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 HORTON DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4238
Mailing Address - Country:US
Mailing Address - Phone:347-204-4629
Mailing Address - Fax:347-426-4765
Practice Address - Street 1:1160 5TH AVE
Practice Address - Street 2:APT 112
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6933
Practice Address - Country:US
Practice Address - Phone:347-204-4629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016390103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical