Provider Demographics
NPI:1346342268
Name:MILLER, AMY DARA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:DARA
Last Name:MILLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 REMINGTON RD
Mailing Address - Street 2:SUITE T
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4833
Mailing Address - Country:US
Mailing Address - Phone:847-845-4045
Mailing Address - Fax:847-519-9089
Practice Address - Street 1:1305 REMINGTON RD
Practice Address - Street 2:SUITE T
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4833
Practice Address - Country:US
Practice Address - Phone:847-845-4045
Practice Address - Fax:847-519-9089
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2021-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-005912103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216-232-73OtherBC/BS PROVIDER ID#
IL36-4313557OtherFEDERAL ID#