Provider Demographics
NPI:1851629240
Name:MILLER, MEREDITH (MA/CAGS)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MA/CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 SE 2ND ST
Mailing Address - Street 2:APT 919
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-3671
Mailing Address - Country:US
Mailing Address - Phone:201-294-6183
Mailing Address - Fax:
Practice Address - Street 1:501 SE 2ND ST
Practice Address - Street 2:APT 919
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-3671
Practice Address - Country:US
Practice Address - Phone:201-294-6183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool