Provider Demographics
NPI:1447941026
Name:KIMBERLY J MILLER PSYD INC
Entity type:Organization
Organization Name:KIMBERLY J MILLER PSYD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:941-504-6980
Mailing Address - Street 1:1328 LOMA LINDA CT
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2426
Mailing Address - Country:US
Mailing Address - Phone:941-504-6980
Mailing Address - Fax:
Practice Address - Street 1:1505 TAMIAMI TRL S STE 401A
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-5562
Practice Address - Country:US
Practice Address - Phone:941-504-6980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty