Provider Demographics
NPI:1740858240
Name:MILLER, SIMONLEIGH P (PH D)
Entity type:Individual
Prefix:
First Name:SIMONLEIGH
Middle Name:P
Last Name:MILLER
Suffix:
Gender:
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-3204
Mailing Address - Country:US
Mailing Address - Phone:646-450-3064
Mailing Address - Fax:
Practice Address - Street 1:733 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-3204
Practice Address - Country:US
Practice Address - Phone:646-450-3064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-12
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00771400103TC0700X
NY027059103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical