Provider Demographics
NPI:1972204808
Name:MILLER, OLIVIA (LP-MHC)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LP-MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 OAK ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2956
Mailing Address - Country:US
Mailing Address - Phone:267-885-8932
Mailing Address - Fax:
Practice Address - Street 1:7 CLAYTON AVE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-2501
Practice Address - Country:US
Practice Address - Phone:607-758-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP120245101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health