Provider Demographics
NPI:1184835928
Name:MINER, ANTHONY ELIOT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:ELIOT
Last Name:MINER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 MOORPARK AVE 300
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2680
Mailing Address - Country:US
Mailing Address - Phone:408-975-2333
Mailing Address - Fax:408-975-2745
Practice Address - Street 1:2400 MOORPARK AVE 300
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2680
Practice Address - Country:US
Practice Address - Phone:408-975-2333
Practice Address - Fax:408-975-2745
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 24677103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist