Provider Demographics
NPI:1922361484
Name:MILLER, COURNEY JAE (MS ED)
Entity Type:Individual
Prefix:MRS
First Name:COURNEY
Middle Name:JAE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1861 GRAND AVENUE
Mailing Address - Street 2:APT A4
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510
Mailing Address - Country:US
Mailing Address - Phone:516-476-9254
Mailing Address - Fax:
Practice Address - Street 1:1861 GRAND AVE
Practice Address - Street 2:APT A4
Practice Address - City:NORTH BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-2400
Practice Address - Country:US
Practice Address - Phone:516-476-9254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1809336174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist