Provider Demographics
NPI:1235285081
Name:MCMILLIN, DIANE MARIAN (MSW)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:MARIAN
Last Name:MCMILLIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 BARNES HILL RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06013-1502
Mailing Address - Country:US
Mailing Address - Phone:860-673-2930
Mailing Address - Fax:
Practice Address - Street 1:43 BARNES HILL RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06013-1502
Practice Address - Country:US
Practice Address - Phone:860-673-2930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0006341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical