Provider Demographics
NPI:1710262548
Name:MILLER, ELIZABETH WEINER (PSYD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:WEINER
Last Name:MILLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 TAYLOR PL
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06890-1196
Mailing Address - Country:US
Mailing Address - Phone:860-614-6571
Mailing Address - Fax:
Practice Address - Street 1:110 TAYLOR PL
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:CT
Practice Address - Zip Code:06890-1196
Practice Address - Country:US
Practice Address - Phone:860-614-6571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021036-1103T00000X
CT004570103T00000X
DC200001239103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist