Provider Demographics
NPI:1841227097
Name:MILLER, RONNIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:
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 1:18 LYMAN ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-1459
Mailing Address - Country:US
Mailing Address - Phone:508-898-2002
Mailing Address - Fax:508-898-2003
Practice Address - Street 1:18 LYMAN ST
Practice Address - Street 2:SUITE 240
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-1459
Practice Address - Country:US
Practice Address - Phone:508-898-2002
Practice Address - Fax:508-898-2003
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4891103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW50462OtherMEDICARE ID - TYPE UNSPECIFIED