Provider Demographics
NPI:1386086551
Name:MILLER, MELISSA R (MS)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:R
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 WATERMAN AVE
Mailing Address - Street 2:APT. # 422
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02911-4100
Mailing Address - Country:US
Mailing Address - Phone:401-248-1169
Mailing Address - Fax:
Practice Address - Street 1:180 WATERMAN AVE
Practice Address - Street 2:APT. # 422
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02911-4100
Practice Address - Country:US
Practice Address - Phone:401-248-1169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-29
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst