Provider Demographics
NPI:1710625702
Name:MILLER, VAUGHN NICHOLAS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:VAUGHN
Middle Name:NICHOLAS
Last Name:MILLER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12345 PARKLAWN DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1725
Mailing Address - Country:US
Mailing Address - Phone:757-775-9001
Mailing Address - Fax:
Practice Address - Street 1:5440 MARINELLI RD APT 406
Practice Address - Street 2:
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-2532
Practice Address - Country:US
Practice Address - Phone:757-775-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810007807103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical