Provider Demographics
NPI:1114460003
Name:MILLER, DOUGLAS JR (MSED SCHOOL PSYCHOL)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:
Last Name:MILLER
Suffix:JR
Gender:M
Credentials:MSED SCHOOL PSYCHOL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:379 MT HOPE RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940
Mailing Address - Country:US
Mailing Address - Phone:845-344-2292
Mailing Address - Fax:845-342-2054
Practice Address - Street 1:379 MT HOPE RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-7135
Practice Address - Country:US
Practice Address - Phone:845-344-2292
Practice Address - Fax:845-342-2054
Is Sole Proprietor?:No
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156033021103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool