Provider Demographics
NPI:1235603804
Name:ADELE MCKEON MILLARD LLC
Entity Type:Organization
Organization Name:ADELE MCKEON MILLARD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICSW
Authorized Official - Prefix:MS
Authorized Official - First Name:ADELE
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:MCKEON-MILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-249-3149
Mailing Address - Street 1:70 WASHINGTON ST STE 404
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3520
Mailing Address - Country:US
Mailing Address - Phone:617-249-3149
Mailing Address - Fax:
Practice Address - Street 1:70 WASHINGTON ST STE 404
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3520
Practice Address - Country:US
Practice Address - Phone:617-249-3149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-17
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty