Provider Demographics
NPI:1982390092
Name:MCMILLAN, ASPEN (MA)
Entity Type:Individual
Prefix:
First Name:ASPEN
Middle Name:
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 J ST APT 130
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-1464
Mailing Address - Country:US
Mailing Address - Phone:732-861-6849
Mailing Address - Fax:
Practice Address - Street 1:25 WASHINGTON LN STE 6A
Practice Address - Street 2:
Practice Address - City:WYNCOTE
Practice Address - State:PA
Practice Address - Zip Code:19095-1400
Practice Address - Country:US
Practice Address - Phone:215-586-3782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009166101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health