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Individual

CARLENE M MACMILLAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
58 N 9TH ST STE 103, BROOKLYN, NY 11249-2018
(929) 227-6577
Mailing address
2 NORTHSIDE PIERS, PH6, BROOKLYN, NY 11249
(929) 227-6577

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
248958
MA
2084P0800X
Psychiatry Physician
278517
NY
2084P0804X
Child & Adolescent Psychiatry Physician
248958
MA
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
278517
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
110094989A
MA
Enumeration date
06/19/2009
Last updated
05/23/2023
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