Provider Demographics
NPI:1558466896
Name:MILLER, LUZ SELENIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LUZ
Middle Name:SELENIA
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LUZ
Other - Middle Name:SELENIA
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:202 QUEBEC RD
Mailing Address - Street 2:
Mailing Address - City:ISLAND PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11558-1526
Mailing Address - Country:US
Mailing Address - Phone:516-889-6232
Mailing Address - Fax:
Practice Address - Street 1:760 BROADWAY # 5A-112
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-5317
Practice Address - Country:US
Practice Address - Phone:718-963-8379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012583103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical