Provider Demographics
NPI:1689795296
Name:MILLER, SCOTT STEVEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:STEVEN
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 STAGER ST
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-2696
Mailing Address - Country:US
Mailing Address - Phone:973-662-9691
Mailing Address - Fax:973-662-9692
Practice Address - Street 1:185 BROAD ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2605
Practice Address - Country:US
Practice Address - Phone:973-662-9692
Practice Address - Fax:973-662-9692
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI3606103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical