Provider Demographics
NPI:1790066132
Name:MILLER, JEFFREY CHARLES (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CHARLES
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 1:366 S CALIFORNIA AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1643
Mailing Address - Country:US
Mailing Address - Phone:650-321-0410
Mailing Address - Fax:
Practice Address - Street 1:366 S CALIFORNIA AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1643
Practice Address - Country:US
Practice Address - Phone:650-321-0410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18489103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY18489OtherCALIFORNIA BOARD OF PSYCHOLOGY LICENSE NUMBER