Provider Demographics
NPI:1376071886
Name:MILLER, MARLA DEBRA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARLA
Middle Name:DEBRA
Last Name:MILLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MALKA
Other - Middle Name:DEBRA
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:4040 ENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1934
Mailing Address - Country:US
Mailing Address - Phone:847-687-2333
Mailing Address - Fax:
Practice Address - Street 1:4040 ENFIELD AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1934
Practice Address - Country:US
Practice Address - Phone:847-687-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-28
Last Update Date:2017-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical