Provider Demographics
NPI:1013089044
Name:MILLER, KEVIN JOHN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JOHN
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-1714
Mailing Address - Country:US
Mailing Address - Phone:973-560-0595
Mailing Address - Fax:973-560-0490
Practice Address - Street 1:135 COLUMBIA TPKE
Practice Address - Street 2:101
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-2104
Practice Address - Country:US
Practice Address - Phone:973-560-0595
Practice Address - Fax:973-560-0490
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3630103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ034221Medicare ID - Type UnspecifiedMEDICARE PROVIDER