Provider Demographics
NPI:1700484623
Name:MILLER, RENA LEE (PHD)
Entity type:Individual
Prefix:DR
First Name:RENA
Middle Name:LEE
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:RACHELI
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:82 NASSAU ST # 60547
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-3703
Mailing Address - Country:US
Mailing Address - Phone:347-948-3362
Mailing Address - Fax:
Practice Address - Street 1:447 BROADWAY FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-2562
Practice Address - Country:US
Practice Address - Phone:347-948-3362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023934103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical