Provider Demographics
NPI:1508426222
Name:MILLER-BOTTOME, MADELEINE (PHD)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:
Last Name:MILLER-BOTTOME
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:415-600-5959
Mailing Address - Fax:415-369-1392
Practice Address - Street 1:601 DUBOCE AVENUE
Practice Address - Street 2:
Practice Address - City:SUITE 250
Practice Address - State:CA
Practice Address - Zip Code:94114-3389
Practice Address - Country:US
Practice Address - Phone:415-600-5959
Practice Address - Fax:415-369-1392
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32847103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent