Provider Demographics
NPI:1598824286
Name:MILLER, HEIDI M (PHD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:M
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 1:275 BICENTENNIAL HWY
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-1900
Mailing Address - Country:US
Mailing Address - Phone:413-796-1622
Mailing Address - Fax:877-358-5498
Practice Address - Street 1:275 BICENTENNIAL HWY
Practice Address - Street 2:SUITE 208
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118-1900
Practice Address - Country:US
Practice Address - Phone:413-796-1622
Practice Address - Fax:877-358-5498
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4260103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMIW04467Medicare ID - Type Unspecified