Provider Demographics
NPI:1841741550
Name:MCMILLAN, JENNIFER (MED)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ANN DR
Mailing Address - Street 2:
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-3201
Mailing Address - Country:US
Mailing Address - Phone:845-596-9903
Mailing Address - Fax:
Practice Address - Street 1:16 ANN DR
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-3201
Practice Address - Country:US
Practice Address - Phone:860-337-1008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-18
Last Update Date:2022-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health