Provider Demographics
NPI:1639293152
Name:MILLER, ANDREW GERARD (MDIV EDS)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:GERARD
Last Name:MILLER
Suffix:
Gender:M
Credentials:MDIV EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 RT 79
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751
Mailing Address - Country:US
Mailing Address - Phone:732-970-0779
Mailing Address - Fax:732-736-1254
Practice Address - Street 1:481 RT 79
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751
Practice Address - Country:US
Practice Address - Phone:732-970-0779
Practice Address - Fax:732-736-1254
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37F100147200106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist