Provider Demographics
NPI:1174735625
Name:MILLER, RICHARD CUSHING (PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CUSHING
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 1:305 RIVIERA CIR
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1508
Mailing Address - Country:US
Mailing Address - Phone:415-924-7954
Mailing Address - Fax:
Practice Address - Street 1:900 5TH AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2959
Practice Address - Country:US
Practice Address - Phone:415-456-3909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 129950174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist