Provider Demographics
NPI:1184334872
Name:LEVEILLE, MILLER ERICK
Entity type:Individual
Prefix:
First Name:MILLER
Middle Name:ERICK
Last Name:LEVEILLE
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 1:422 HOPE ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06906-1326
Mailing Address - Country:US
Mailing Address - Phone:475-205-2915
Mailing Address - Fax:
Practice Address - Street 1:422 HOPE ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06906-1326
Practice Address - Country:US
Practice Address - Phone:475-205-2915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4928274103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst