Provider Demographics
NPI:1073920401
Name:MILLER, MAXINE (MED, MT-BC)
Entity Type:Individual
Prefix:
First Name:MAXINE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MED, MT-BC
Other - Prefix:
Other - First Name:MAXINE
Other - Middle Name:MILLER
Other - Last Name:VOGT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED, MT-BC
Mailing Address - Street 1:770 WOODLANE RD
Mailing Address - Street 2:
Mailing Address - City:WESTAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-3804
Mailing Address - Country:US
Mailing Address - Phone:609-267-5928
Mailing Address - Fax:
Practice Address - Street 1:499 COOPER LANDING RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2504
Practice Address - Country:US
Practice Address - Phone:856-482-8747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health