Provider Demographics
NPI:1235822230
Name:WILLIS, MILES ALVES
Entity type:Individual
Prefix:
First Name:MILES
Middle Name:ALVES
Last Name:WILLIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 7TH AVE STE 1106
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-0029
Mailing Address - Country:US
Mailing Address - Phone:646-797-4340
Mailing Address - Fax:646-205-8238
Practice Address - Street 1:850 7TH AVE STE 1106
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-0029
Practice Address - Country:US
Practice Address - Phone:646-797-4340
Practice Address - Fax:646-205-8238
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health