Provider Demographics
NPI:1366035313
Name:MILLER, TAROLD (MED)
Entity Type:Individual
Prefix:MR
First Name:TAROLD
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 WILDEMERE AVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-1838
Mailing Address - Country:US
Mailing Address - Phone:617-750-9398
Mailing Address - Fax:203-841-1047
Practice Address - Street 1:68 WILDEMERE AVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-1838
Practice Address - Country:US
Practice Address - Phone:617-750-9398
Practice Address - Fax:203-841-1047
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst