Provider Demographics
NPI:1285650218
Name:MCMILLAN, ROBERT CAMPBELL (PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CAMPBELL
Last Name:MCMILLAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1361 ELM ST
Mailing Address - Street 2:SUITE 407
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101
Mailing Address - Country:US
Mailing Address - Phone:603-668-3050
Mailing Address - Fax:603-668-8666
Practice Address - Street 1:1361 ELM ST
Practice Address - Street 2:SUITE 407
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101
Practice Address - Country:US
Practice Address - Phone:603-668-3050
Practice Address - Fax:603-668-8666
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH279103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH99002249Medicaid
NH99002249Medicaid
NH2249Medicare ID - Type Unspecified