Provider Demographics
NPI:1699911396
Name:STIFF MILLER, MARY ABIGAIL (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ABIGAIL
Last Name:STIFF MILLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:ABIGAIL
Other - Last Name:STIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:2024 SPEED AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1236
Mailing Address - Country:US
Mailing Address - Phone:502-767-8798
Mailing Address - Fax:
Practice Address - Street 1:1161 E BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1711
Practice Address - Country:US
Practice Address - Phone:502-561-0952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-30
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1524103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical