Provider Demographics
NPI:1932242583
Name:MILES, DENISE LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:LYNN
Last Name:MILES
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 1:576 6TH AVE
Mailing Address - Street 2:APT. 3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-8400
Mailing Address - Country:US
Mailing Address - Phone:718-344-2634
Mailing Address - Fax:718-765-2574
Practice Address - Street 1:60 PLAZA ST E
Practice Address - Street 2:SUITE 1K
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-5025
Practice Address - Country:US
Practice Address - Phone:347-316-8575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017066-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300038054OtherPTAN