Provider Demographics
NPI:1679636179
Name:MCMILLAN, RONNI L
Entity Type:Individual
Prefix:MRS
First Name:RONNI
Middle Name:L
Last Name:MCMILLAN
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 1:219 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-3105
Mailing Address - Country:US
Mailing Address - Phone:781-431-2277
Mailing Address - Fax:781-431-7770
Practice Address - Street 1:219 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-3105
Practice Address - Country:US
Practice Address - Phone:781-431-2277
Practice Address - Fax:781-431-7770
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA1014501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP21934Medicare ID - Type Unspecified