MEDICARE: MAREN HART MCMILLAN PSYD LP

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	103T00000X	Psychologist	LP4624	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881619534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAREN HART MCMILLAN PSYD LP

Provider Business Mailing Address
First Line	:	2324 UNIVERSITY W AVE 120
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1854
Country	:	US
Telephone Number	:	651-644-4100
Fax Number	:	651-644-4885

Provider Business Practice Location Address
First Line	:	2324 UNIVERSITY W AVE 120
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1854
Country	:	US
Telephone Number	:	651-644-4100
Fax Number	:

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	08/07/2015

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