Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 4462 | MA |
N | 103TC0700X | Clinical Psychologist | 4462 | MA |
N | 103TA0700X | Adult Development & Aging Psychologist | 4462 | MA |
N | 103G00000X | Clinical Psychologist | 4462 | MA |
N | 103TC0700X | Clinical Psychologist | 4462 | MA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 4462 | MA |
N | 103TS0200X | School Psychologist | 166523 | MA |
NPI | 1558380360 |
---|---|
Provider Name | Dr. John Miner |
First Address | Boston, MA 02135-1411 |
Second Address | Chestnut Hill, MA 02467-1435 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0495668 | UNITED BEHAVIORAL HEALTH (01) | MA |
0518255 | (05) | MA |
13632 | HANCOCK (01) | MA |
732087 | TUFTS HEALTH CARE (01) | MA |
7764376 | AETNA (01) | MA |
R44639 | (02) | MA |