Provider Demographics
NPI:1629326699
Name:MILLER, CARLY MEREDITH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CARLY
Middle Name:MEREDITH
Last Name:MILLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 W 83RD ST
Mailing Address - Street 2:APT#16J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-4952
Mailing Address - Country:US
Mailing Address - Phone:917-626-5913
Mailing Address - Fax:
Practice Address - Street 1:225 W 83RD ST
Practice Address - Street 2:APT#16J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-4952
Practice Address - Country:US
Practice Address - Phone:917-626-5913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-24
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019722103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical