Individual provider Active NPI

Holly J Miller, PSY.D.

  • Clinical Psychologist
  • West Hartford, CT
National Provider Identifier
1790321644
Registry record updated Oct 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
3894 Issued in CT
Practice address
22 Fennbrook Rd
West Hartford, CT 06119-2204
Phone
(860) 841-2251
NPI assigned
Nov 25, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Cognitive & Behavioral Psychologist 103TB0200X 3894 CT
Clinical Psychologist 103TC0700X PSY11810 MA
School Psychologist 103TS0200X 3894 CT
Clinical Psychologist 103TC0700X 3894 CT Primary

Addresses

Primary practice location

22 Fennbrook Rd
West Hartford, CT 06119-2204

Mailing address

22 Fennbrook Rd
West Hartford, CT 06119-2204
Phone (860) 841-2251

Other practice location 1

300 Longwood Ave
Boston, MA 02115-5724
Phone (617) 355-6000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231025000919 MA Practitioner - Clinical Psychologist 7911353156 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3894CTMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Connecticut Behavioral Health, LLC Cognitive & Behavioral CurrentSince Dec 1, 2019 Accepting new patients
CHMC Otolaryngologic Foundation, Inc Clinical CurrentSince Nov 6, 2023 Accepting new patients

Locations

673 S Main St
Cheshire, CT 06410
Phone (203) 271-1430

300 Longwood Ave
Boston, MA 02115
Phone (617) 355-4956

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1574640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697068800000",
    "number": "1790321644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 FENNBROOK RD",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061192204",
            "telephone_number": "860-841-2251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 FENNBROOK RD",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061192204",
            "telephone_number": "860-841-2251"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 Longwood Ave",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021155724",
            "country_code": "US",
            "telephone_number": "617-355-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MILLER",
        "first_name": "HOLLY",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-25",
        "last_updated": "2023-10-12",
        "certification_date": "2023-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "CT",
            "license": "3894",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "PSY11810",
            "primary": false
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "CT",
            "license": "3894",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CT",
            "license": "3894",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Hartford, CT

Sources for this page

Verify at the official NPI Registry.