Provider Demographics
NPI:1104338813
Name:MILLAR, SUZI (PSYD)
Entity type:Individual
Prefix:DR
First Name:SUZI
Middle Name:
Last Name:MILLAR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BOULEVARD OF EAGLES
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-4002
Mailing Address - Country:US
Mailing Address - Phone:732-289-8785
Mailing Address - Fax:
Practice Address - Street 1:50 BOULEVARD OF EAGLES
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-4002
Practice Address - Country:US
Practice Address - Phone:732-289-8785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5646103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent