Provider Demographics
NPI:1588762496
Name:MILLER, LAURA J
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:MILLER
Suffix:
Gender:F
Credentials:
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Mailing Address - Street 1:75 FRANCIS ST
Mailing Address - Street 2:BRIGHAM AND WOMEN'S HOSPITAL, DEPT. OF PSYCHIATRY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6110
Mailing Address - Country:US
Mailing Address - Phone:617-525-7469
Mailing Address - Fax:617-264-6326
Practice Address - Street 1:221 LONGWOOD AVE
Practice Address - Street 2:BRIGHAM PSYCHIATRIC SPECIALTIES, 4TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5804
Practice Address - Country:US
Practice Address - Phone:617-732-6753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2012-06-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2421352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
D89338Medicare UPIN