Provider Demographics
NPI:1649386228
Name:KUNKLE-MILLER, CAROLE L (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:L
Last Name:KUNKLE-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 1:1720 WASHINGTON RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15241-1208
Mailing Address - Country:US
Mailing Address - Phone:412-854-4887
Mailing Address - Fax:412-386-3733
Practice Address - Street 1:1720 WASHINGTON RD
Practice Address - Street 2:SUITE 208
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241-1208
Practice Address - Country:US
Practice Address - Phone:412-854-4887
Practice Address - Fax:412-386-3733
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004214L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1588704944OtherNPI
PA081894OtherMEDICARE PTAN
PA1417062480OtherNPI
PA1619196987OtherGROUP NPI
PA630614OtherBLUE CROSS GROUP
PA1336286772OtherNPI JA
PA1457375784OtherNPI
PA1485089OtherBLUE SHIELD
PA139591OtherBLUE CROSS
PA1588704944OtherNPI
PA630614OtherBLUE CROSS GROUP
PA1485089OtherBLUE SHIELD