MEDICARE: ASPEN MCMILLAN MA

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	101YM0800X	Mental Health Counselor	PC009166	PA

General Provider Information

NPI Number	:	1982390092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASPEN MCMILLAN MA

Provider Business Mailing Address
First Line	:	3400 J ST APT 130
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-1464
Country	:	US
Telephone Number	:	732-861-6849
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 WASHINGTON LN STE 6A
Second Line	:
City	:	WYNCOTE
State	:	PA
Zip	:	19095-1400
Country	:	US
Telephone Number	:	215-586-3782
Fax Number	:

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

Provider Enumeration Date	:	04/12/2023
Last Update Date	:	04/12/2023

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Directions to “ ASPEN MCMILLAN MA” Practice Location

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