Provider Demographics
NPI:1720167935
Name:MILLEN, MEREDITH A (MAED)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:A
Last Name:MILLEN
Suffix:
Gender:F
Credentials:MAED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 N PLANK RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-2111
Mailing Address - Country:US
Mailing Address - Phone:914-906-8831
Mailing Address - Fax:845-851-8139
Practice Address - Street 1:17 N PLANK RD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-2111
Practice Address - Country:US
Practice Address - Phone:914-906-8831
Practice Address - Fax:845-566-6508
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002784101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health