Provider Demographics
NPI:1912993676
Name:MILLER, LAURENCE (PHD)
Entity type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 CAMINO GARDENS BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-5828
Mailing Address - Country:US
Mailing Address - Phone:561-392-8881
Mailing Address - Fax:561-451-2822
Practice Address - Street 1:399 CAMINO GARDENS BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-5828
Practice Address - Country:US
Practice Address - Phone:561-392-8881
Practice Address - Fax:561-451-2822
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004413103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73704Medicare ID - Type Unspecified