Basic Information
| Provider Information | |||||||||
| NPI: | 1346265485 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | COLLEEN | ||||||||
| MiddleName: | A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5733 E LAKE RD | ||||||||
| Address2: | |||||||||
| City: | CAZENOVIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130359324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3156552740 | ||||||||
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| Practice Location | |||||||||
| Address1: | 138 N COURT ST. | ||||||||
| Address2: | VETERANS MEMORIAL BUILDING | ||||||||
| City: | WAMPSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 131630608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153662327 | ||||||||
| FaxNumber: | 3153662599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | R050997-1 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | RO50997-1 | NY | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.