Provider Demographics
NPI:1629567375
Name:TAYLOR, MILTON HERBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:MILTON
Middle Name:HERBERT
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:MILTON
Other - Middle Name:HERBERT
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:30 ENAYA CIR
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-1258
Mailing Address - Country:US
Mailing Address - Phone:978-751-4226
Mailing Address - Fax:
Practice Address - Street 1:338 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-2143
Practice Address - Country:US
Practice Address - Phone:978-751-4226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2167103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist