Provider Demographics
NPI:1457657066
Name:MILLER, JANA (MS)
Entity Type:Individual
Prefix:MS
First Name:JANA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 MALTA AVE
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-1529
Mailing Address - Country:US
Mailing Address - Phone:518-884-7290
Mailing Address - Fax:518-884-7286
Practice Address - Street 1:70 MALTA AVE
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-1529
Practice Address - Country:US
Practice Address - Phone:518-884-7290
Practice Address - Fax:518-884-7286
Is Sole Proprietor?:No
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY592517101YS0200X
NY1636425103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool