Provider Demographics
NPI:1538806948
Name:MILLER, BRIDGET IVY
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:IVY
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 MAGNOLIA TREE CT APT A42
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-7283
Mailing Address - Country:US
Mailing Address - Phone:240-439-3994
Mailing Address - Fax:
Practice Address - Street 1:19540 AMARANTH DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1202
Practice Address - Country:US
Practice Address - Phone:240-830-7233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty