MEDICARE: DR. IVY ELIZABETH ROLLINS MILLIKEN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist		RI
2	103TC0700X	Clinical Psychologist	PS01921	RI

General Provider Information

NPI Number	:	1528653896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IVY ELIZABETH ROLLINS MILLIKEN PH.D.

Provider Business Mailing Address
First Line	:	6 WOODHAVEN RD
Second Line	:
City	:	BARRINGTON
State	:	RI
Zip	:	02806-4322
Country	:	US
Telephone Number	:	401-406-1355
Fax Number	:

Provider Business Practice Location Address
First Line	:	789 PARK AVE
Second Line	:
City	:	CRANSTON
State	:	RI
Zip	:	02910-2036
Country	:	US
Telephone Number	:	401-421-4561
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2021
Last Update Date	:	01/20/2026

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