Provider Demographics
NPI:1609066406
Name:MILLER, ERIC M (PHD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:M
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 N CALIFORNIA AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-3965
Mailing Address - Country:US
Mailing Address - Phone:650-296-6809
Mailing Address - Fax:
Practice Address - Street 1:145 N CALIFORNIA AVE STE 2
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-3965
Practice Address - Country:US
Practice Address - Phone:650-394-7333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23283103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical