Provider Demographics
NPI:1578692885
Name:MILLER, CANDICE S
Entity Type:Individual
Prefix:MS
First Name:CANDICE
Middle Name:S
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 1:697 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-3271
Mailing Address - Country:US
Mailing Address - Phone:914-967-8786
Mailing Address - Fax:914-921-6831
Practice Address - Street 1:31 PURCHASE ST
Practice Address - Street 2:SUITE 3-5
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-3013
Practice Address - Country:US
Practice Address - Phone:914-921-0020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO136151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN53141Medicare PIN