Provider Demographics
NPI:1407096928
Name:MILTON, DEBORAH LAVENNIA (MM)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:LAVENNIA
Last Name:MILTON
Suffix:
Gender:F
Credentials:MM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 DALE ST
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-2274
Mailing Address - Country:US
Mailing Address - Phone:617-543-2764
Mailing Address - Fax:617-442-3825
Practice Address - Street 1:394 TRUMAN HIGHWAY
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186
Practice Address - Country:US
Practice Address - Phone:617-543-4357
Practice Address - Fax:617-364-1664
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health