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General NPI Number Information
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NPI Number | 1144261009
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Entity Type | Organization
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Legal Business Name | MILESTONE PSYCHIATRIC & PSYCHOLOGICAL SERVICES P C
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 09/07/2007
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Provider Practice Location Address
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Address Line | 23 MAIN ST SUITE # 102
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City | HORNELL
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State | NY
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Zip | 14843-1536
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Country | US
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Telephone | 607-324-9240
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Fax |
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Provider Business Mailing Address
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Address Line | 23 MAIN ST SUITE # 102
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City | HORNELL
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State | NY
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Zip | 14843-1536
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Country | US
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Telephone | 607-324-9240
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAJA RAO
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Credential | M.D
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Telephone | 607-324-9240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 144594
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License Number State | NY
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