Provider Demographics
NPI:1457971863
Name:MILLER, SAMANTHA LYNNE (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:LYNNE
Last Name:MILLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 CHAPPAQUA RD
Mailing Address - Street 2:
Mailing Address - City:BRIARCLIFF MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10510-1533
Mailing Address - Country:US
Mailing Address - Phone:646-319-6752
Mailing Address - Fax:
Practice Address - Street 1:34 S BROADWAY STE 506
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4429
Practice Address - Country:US
Practice Address - Phone:914-730-9221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-26
Last Update Date:2020-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015172103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical