Provider Demographics
NPI:1619304896
Name:MILLAR, ADELINE (MED, CAGS)
Entity Type:Individual
Prefix:MS
First Name:ADELINE
Middle Name:
Last Name:MILLAR
Suffix:
Gender:F
Credentials:MED, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 STANWOOD ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02121-2725
Mailing Address - Country:US
Mailing Address - Phone:857-222-8753
Mailing Address - Fax:
Practice Address - Street 1:119 STANWOOD ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02121-2725
Practice Address - Country:US
Practice Address - Phone:857-222-8753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10310101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health