Provider Demographics
NPI:1407106206
Name:PETER A. MILLER PSYCHOTHERAPY & CONSULTING, LLC
Entity Type:Organization
Organization Name:PETER A. MILLER PSYCHOTHERAPY & CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:609-921-6070
Mailing Address - Street 1:43 TAMARACK CIR
Mailing Address - Street 2:
Mailing Address - City:SKILLMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08558-2054
Mailing Address - Country:US
Mailing Address - Phone:609-921-6070
Mailing Address - Fax:609-921-6070
Practice Address - Street 1:43 TAMARACK CIR
Practice Address - Street 2:
Practice Address - City:SKILLMAN
Practice Address - State:NJ
Practice Address - Zip Code:08558-2054
Practice Address - Country:US
Practice Address - Phone:609-921-6070
Practice Address - Fax:609-921-6070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001769001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ611634Medicare PIN