Doctor Name: | MRS. ELYSE AMY MILLER |
NPI Number: | 1073684882 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCAT |
License Number: | 000021 |
Business Practice Address: | 1000 Park Blvd Unit F Massapequa Park, NY - 117622740 |
Business Phone Number: | 5169842712 |
Business Fax Number: | |
Mailing Address: | 22 Wagon Ln, LEVITTOWN |
State: | NY |
Postal Code: | 117564112 |
Phone Number: | 5167358891 |
Fax Number: | |
NPI Enumeration Date: | 11/13/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 000021 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |