Provider Demographics
NPI:1558909929
Name:MILLER, KIM
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CAROUSEL CT
Mailing Address - Street 2:
Mailing Address - City:MILLSTONE TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08510-8761
Mailing Address - Country:US
Mailing Address - Phone:848-863-9097
Mailing Address - Fax:
Practice Address - Street 1:59 THROCKMORTON ST
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-1946
Practice Address - Country:US
Practice Address - Phone:732-431-0647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37C00703500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional