Provider Demographics
NPI:1902002561
Name:GERIATRIC PSYCHIATRY ASSOCIATES, PC
Entity Type:Organization
Organization Name:GERIATRIC PSYCHIATRY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-655-1559
Mailing Address - Street 1:17 OLD KINGS HWY S
Mailing Address - Street 2:SUITE 1-2
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-4522
Mailing Address - Country:US
Mailing Address - Phone:203-655-1559
Mailing Address - Fax:203-655-1914
Practice Address - Street 1:17 OLD KINGS HWY S
Practice Address - Street 2:SUITE 1-2
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4522
Practice Address - Country:US
Practice Address - Phone:203-655-1559
Practice Address - Fax:203-655-1914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC00819Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER