Provider Demographics
NPI:1528151909
Name:MILLER, LAWRENCE ANTHONY (PSYD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:ANTHONY
Last Name:MILLER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 N MAYFAIR RD FL 3
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3464
Mailing Address - Country:US
Mailing Address - Phone:414-955-8900
Mailing Address - Fax:414-955-6299
Practice Address - Street 1:1155 N MAYFAIR RD FL 3
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3464
Practice Address - Country:US
Practice Address - Phone:414-955-8900
Practice Address - Fax:414-955-6299
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71006826103T00000X
WI2477103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1528151909Medicaid