Provider Demographics
NPI:1275740680
Name:MILLER, ROBERT F (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:F
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1191 CHASE RD SE
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:44615-9619
Mailing Address - Country:US
Mailing Address - Phone:330-575-5364
Mailing Address - Fax:330-627-4076
Practice Address - Street 1:1196 KENSINGTON RD NE
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:44615-9763
Practice Address - Country:US
Practice Address - Phone:330-575-5364
Practice Address - Fax:330-627-4076
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6424103T00000X
OHS. 0017766104100000X
OHE-1959101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3000666Medicaid
OH3000666Medicaid