Provider Demographics
NPI:1649242371
Name:MILLER, DAVID (EDD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 HAGAN DR
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-5095
Mailing Address - Country:US
Mailing Address - Phone:845-462-6231
Mailing Address - Fax:845-462-6231
Practice Address - Street 1:27 HAGAN DR
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-5095
Practice Address - Country:US
Practice Address - Phone:845-462-6231
Practice Address - Fax:845-462-6231
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3725103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V07331Medicare ID - Type Unspecified