Provider Demographics
NPI:1598157729
Name:MACMILLAN, RAEANNE
Entity Type:Individual
Prefix:
First Name:RAEANNE
Middle Name:
Last Name:MACMILLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 TENNENT RD STE 202
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3149
Mailing Address - Country:US
Mailing Address - Phone:732-766-1238
Mailing Address - Fax:
Practice Address - Street 1:710 TENNENT RD STE 202
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3149
Practice Address - Country:US
Practice Address - Phone:732-766-1238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-25
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001758221700000X
NJ16LP00016100221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist