T.Stacey McMillan, LPT, LMFT, PH.D.
Individual provider Active NPI Psychologist · Keyport, NJ
NPI 1972932424 · NPPES record last updated Nov 5, 2013
Key facts
- NPI
- 1972932424
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- TM714709D (FL)
- Practice address
- 43 W Front St Ste B
Keyport, NJ 07735-3601 - Phone
- (732) 407-0006
- Fax
- (732) 518-5032
- NPI assigned
- Nov 5, 2013
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TM714709D | FL | MD | Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | TM714709D | FL | Yes |
Addresses
Primary practice location
43 W Front St Ste B
Keyport, NJ 07735-3601
Mailing address
PO Box 728
Keyport, NJ 07735-0728
Phone (732) 497-0666
Other providers in Keyport, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 5, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.