MEDICARE: MATTHEW MULKEARNS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106E00000X	Assistant Behavior Analyst	0-15-6781
2	103K00000X	Behavior Analyst	1-20-43893	FL

General Provider Information

NPI Number	:	1346678117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW MULKEARNS

Provider Business Mailing Address
First Line	:	5 REVERE DR STE 120
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-8005
Country	:	US
Telephone Number	:	847-807-3717
Fax Number	:	847-348-3706

Provider Business Practice Location Address
First Line	:	6196 LAKE GRAY BLVD STE 116
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-5867
Country	:	US
Telephone Number	:	800-356-4049
Fax Number	:	941-485-0519

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2013
Last Update Date	:	09/21/2020

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Directions to “ MATTHEW MULKEARNS ” Practice Location

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