Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 4627 | MA |
N | 103TC0700X | Clinical Psychologist | 4627 | MA |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 4627 | MA |
NPI | 1134309974 |
---|---|
Provider Name | Dr. Iris Lynn Miller |
First Address | Waban, MA 02468-1519 |
Second Address | Waban, MA 02468-1519 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2007 |
Last Update Date | 09/11/2007 |