Provider Demographics
NPI:1518194018
Name:MACMILLAN, ADELE STEWART (LCSW)
Entity Type:Individual
Prefix:
First Name:ADELE
Middle Name:STEWART
Last Name:MACMILLAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 SYCAMORE DR
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11937-1438
Mailing Address - Country:US
Mailing Address - Phone:631-324-6769
Mailing Address - Fax:
Practice Address - Street 1:22 SYCAMORE DR
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11937-1438
Practice Address - Country:US
Practice Address - Phone:631-324-6769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076645-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical