Organization
MARIA D. MILILLO, PH.D. PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARIA MILILLO PH.D. (PRESIDENT)
(612) 879-0414
Entity
Organization
Contact information
Practice address
15 GROVELAND TER, 201, MINNEAPOLIS, MN 55403-1154
(612) 879-0414
Mailing address
8183 JULIANNE TER, MINNEAPOLIS, MN 55427-3928
(612) 879-0414
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP0579
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
57648MI
BLUE CROSS BLUE SHIELD
MN
05
—
942747300
—
MN
Enumeration date
01/29/2008
Last updated
07/10/2015
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