Provider Demographics
NPI:1558553750
Name:MILLER, TIFFANY CORNELIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:CORNELIA
Last Name:MILLER
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 1:812 W 181ST ST APT 33
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-4555
Mailing Address - Country:US
Mailing Address - Phone:347-693-9683
Mailing Address - Fax:212-928-2310
Practice Address - Street 1:5030 BROADWAY
Practice Address - Street 2:SUITE 616
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-1655
Practice Address - Country:US
Practice Address - Phone:347-693-9683
Practice Address - Fax:212-928-2310
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017670103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical