Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 3630 | NJ |
Y | 103TC0700X | Clinical Psychologist | 3630 | NJ |
NPI | 1013089044 |
---|---|
Provider Name | Dr. Kevin John Miller |
First Address | East Hanover, NJ 07936-1714 |
Second Address | Florham Park, NJ 07932-2104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 08/07/2007 |