Provider Demographics
NPI:1700930112
Name:MILLER, AMY MARCEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:MARCEL
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 1:8580 UTICA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4870
Mailing Address - Country:US
Mailing Address - Phone:909-944-1717
Mailing Address - Fax:909-948-5199
Practice Address - Street 1:8580 UTICA AVE STE 200
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4870
Practice Address - Country:US
Practice Address - Phone:909-944-1717
Practice Address - Fax:909-948-5199
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10372101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health