MEDICARE: MS. JILL MULLIN MA, MSED, BCBA

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	174400000X	Specialist	1130497	NY
2	103K00000X	Behavior Analyst	1031160

General Provider Information

NPI Number	:	1427328335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JILL MULLIN MA, MSED, BCBA

Provider Business Mailing Address
First Line	:	3545 82ND ST APT 51
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-5138
Country	:	US
Telephone Number	:	209-471-2212
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 CLINTON ST
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-4914
Country	:	US
Telephone Number	:	207-408-2701
Fax Number	:

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

Provider Enumeration Date	:	01/09/2012
Last Update Date	:	07/10/2019

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