Provider Demographics
NPI:1174665582
Name:MILLON, MICHELE L (PSYD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:L
Last Name:MILLON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3747
Mailing Address - Country:US
Mailing Address - Phone:617-547-0703
Mailing Address - Fax:
Practice Address - Street 1:333 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3747
Practice Address - Country:US
Practice Address - Phone:617-547-0703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7552103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1854607Medicaid
MAW05871OtherBLUE CROSS BLUE SHIELD
MA1854607Medicaid