Provider Demographics
NPI:1144261009
Name:MILESTONE PSYCHIATRIC & PSYCHOLOGICAL SERVICES P C
Entity type:Organization
Organization Name:MILESTONE PSYCHIATRIC & PSYCHOLOGICAL SERVICES P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-324-9240
Mailing Address - Street 1:23 MAIN ST
Mailing Address - Street 2:SUITE # 102
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1536
Mailing Address - Country:US
Mailing Address - Phone:607-324-9240
Mailing Address - Fax:
Practice Address - Street 1:23 MAIN ST
Practice Address - Street 2:SUITE # 102
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1536
Practice Address - Country:US
Practice Address - Phone:607-324-9240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 363LP0808X
NY1445942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty