Provider Demographics
NPI:1023525474
Name:MILLER, AMBER DIAMOND
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:DIAMOND
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 NW 21ST ST APT 304
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33311-3108
Mailing Address - Country:US
Mailing Address - Phone:786-326-1600
Mailing Address - Fax:
Practice Address - Street 1:1730 SOUTH FEDERAL HIGHWAY
Practice Address - Street 2:268
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483
Practice Address - Country:US
Practice Address - Phone:305-305-6367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician