Provider Demographics
NPI:1104976745
Name:MILLER, BRUCE NILS (PHD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:NILS
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1010
Mailing Address - Country:US
Mailing Address - Phone:973-783-6232
Mailing Address - Fax:973-509-5206
Practice Address - Street 1:250 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1010
Practice Address - Country:US
Practice Address - Phone:973-783-6232
Practice Address - Fax:973-509-5206
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100188900103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist