Provider Demographics
NPI:1780340562
Name:MILLAN, JENNIFER (LMSW)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:MILLAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 HICKSVILLE RD APT 1G
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-3432
Mailing Address - Country:US
Mailing Address - Phone:516-643-0809
Mailing Address - Fax:
Practice Address - Street 1:8725 136TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1924
Practice Address - Country:US
Practice Address - Phone:718-291-2807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110748-011041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool