Provider Demographics
NPI:1992074207
Name:SMITH-MILLAN, MELISSA JILL
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JILL
Last Name:SMITH-MILLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WATER ST
Mailing Address - Street 2:SIUH
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-2709
Mailing Address - Country:US
Mailing Address - Phone:718-448-3976
Mailing Address - Fax:
Practice Address - Street 1:111 WATER ST
Practice Address - Street 2:SIUH
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-2709
Practice Address - Country:US
Practice Address - Phone:718-448-3976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)