Provider Demographics
NPI:1841598653
Name:MILLER, NANCY FAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:FAY
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 DOUGLASS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2524
Mailing Address - Country:US
Mailing Address - Phone:207-874-8225
Mailing Address - Fax:207-874-8292
Practice Address - Street 1:57 DOUGLASS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2524
Practice Address - Country:US
Practice Address - Phone:207-874-8225
Practice Address - Fax:207-874-8292
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1201103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist