Provider Demographics
NPI:1255991998
Name:MILLER, MARY KATE
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATE
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4735 OGLETOWN STANTON RD STE 2223
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-8000
Mailing Address - Country:US
Mailing Address - Phone:302-623-2943
Mailing Address - Fax:302-623-0201
Practice Address - Street 1:4735 OGLETOWN STANTON RD STE 2223
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-8000
Practice Address - Country:US
Practice Address - Phone:302-623-2943
Practice Address - Fax:302-623-0201
Is Sole Proprietor?:No
Enumeration Date:2019-06-15
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11158103TC0700X
DEB1-0011531103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110157395AMedicaid