Provider Demographics
NPI:1679147813
Name:MILLER, REBECCA DONOVAN
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:DONOVAN
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 1:401 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:GREEN LANE
Mailing Address - State:PA
Mailing Address - Zip Code:18054-2247
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 WALNUT ST
Practice Address - Street 2:
Practice Address - City:GREEN LANE
Practice Address - State:PA
Practice Address - Zip Code:18054-2247
Practice Address - Country:US
Practice Address - Phone:267-644-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst