Provider Demographics
NPI:1073684882
Name:MILLER, ELYSE AMY (LCAT)
Entity Type:Individual
Prefix:MRS
First Name:ELYSE
Middle Name:AMY
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 WAGON LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-4112
Mailing Address - Country:US
Mailing Address - Phone:516-735-8891
Mailing Address - Fax:
Practice Address - Street 1:1000 PARK BLVD UNIT F
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-2740
Practice Address - Country:US
Practice Address - Phone:516-984-2712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000021101YM0800X
NY000021-1221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist