Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 1366 | MA |
Y | 103T00000X | Psychologist | 1366 | MA |
NPI | 1013053719 |
---|---|
Provider Name | Ms. Amy L. Miller |
First Address | Peterborough, NH 03458-1262 |
Second Address | Fitchburg, MA 01420-4566 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 08/07/2007 |