Provider Demographics
NPI:1316934607
Name:MILLMAN, DARYL LYNN (PHD)
Entity type:Individual
Prefix:DR
First Name:DARYL
Middle Name:LYNN
Last Name:MILLMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 SMUGGLERS CV
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-2636
Mailing Address - Country:US
Mailing Address - Phone:772-234-6038
Mailing Address - Fax:772-234-9287
Practice Address - Street 1:2770 INDIAN RIVER BLVD.
Practice Address - Street 2:SUITE 313
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6550
Practice Address - Country:US
Practice Address - Phone:772-569-0055
Practice Address - Fax:772-234-9287
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-01
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5237103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54228Medicare ID - Type Unspecified
54228Medicare PIN