Provider Demographics
NPI:1649576927
Name:MILLER, CARLA JEAN
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:JEAN
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:792 WOLCOTT HILL RD
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-3375
Mailing Address - Country:US
Mailing Address - Phone:860-529-6112
Mailing Address - Fax:
Practice Address - Street 1:792 WOLCOTT HILL RD
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-3375
Practice Address - Country:US
Practice Address - Phone:860-529-6112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst