Provider Demographics
NPI:1841441060
Name:MILLER, TAMARA AVIVA (PSYD)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:AVIVA
Last Name:MILLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 NEVIN AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94801-3143
Mailing Address - Country:US
Mailing Address - Phone:510-307-1668
Mailing Address - Fax:
Practice Address - Street 1:11344 COLOMA RD
Practice Address - Street 2:STE 605
Practice Address - City:GOLD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95670-4463
Practice Address - Country:US
Practice Address - Phone:510-307-1668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26743103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist