Provider Demographics
NPI:1689706103
Name:BORDEN MILLER, BETTY (PHD)
Entity Type:Individual
Prefix:DR
First Name:BETTY
Middle Name:
Last Name:BORDEN MILLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:BETTY
Other - Middle Name:L
Other - Last Name:BORDEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:3033 DOYNE RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-1110
Mailing Address - Country:US
Mailing Address - Phone:626-398-7105
Mailing Address - Fax:626-398-7105
Practice Address - Street 1:3033 DOYNE RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-1110
Practice Address - Country:US
Practice Address - Phone:626-398-7105
Practice Address - Fax:626-398-7105
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5289103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY052891Medicaid
CAPSY052891Medicaid