Provider Demographics
NPI:1639386774
Name:MILLER, WENDY ELLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:ELLEN
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 1:303 MERCER ST APT B104
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-6728
Mailing Address - Country:US
Mailing Address - Phone:212-475-3151
Mailing Address - Fax:
Practice Address - Street 1:14 E 4TH ST
Practice Address - Street 2:SUITE 402
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-1155
Practice Address - Country:US
Practice Address - Phone:212-475-3151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008984-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical