Basic Information
| Provider Information | |||||||||
| NPI: | 1295350239 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | DEBRA | ||||||||
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| Credential: | MHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 741 DELAWARE AVE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142092201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7162181400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 67 E PEARL ST | ||||||||
| Address2: | |||||||||
| City: | WELLSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 148951118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5855932015 | ||||||||
| FaxNumber: | 7163723886 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2020 | ||||||||
| LastUpdateDate: | 02/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | P100819 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.