Provider Demographics
NPI:1518045889
Name:MILLER, TANIA MARA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TANIA
Middle Name:MARA
Last Name:MILLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 N 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2418
Mailing Address - Country:US
Mailing Address - Phone:732-545-0287
Mailing Address - Fax:
Practice Address - Street 1:9 N 2ND AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2418
Practice Address - Country:US
Practice Address - Phone:732-545-0287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017013103T00000X
NJ35S100444200103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist