Provider Demographics
NPI:1083990238
Name:MILLER, RICHARD (LPC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 W MAIN ST APT 4B
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07727-1034
Mailing Address - Country:US
Mailing Address - Phone:201-380-1116
Mailing Address - Fax:
Practice Address - Street 1:201 13TH ST
Practice Address - Street 2:
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650-2006
Practice Address - Country:US
Practice Address - Phone:201-380-1116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2022-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RW00369100183700000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No183700000XPharmacy Service ProvidersPharmacy Technician