Healthcare Provider Details

I. General information

NPI: 1174072805
Provider Name (Legal Business Name): CIARA CHLOE MULVENA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2016
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 NW 68TH ST
FORT LAUDERDALE FL
33309-1206
US

IV. Provider business mailing address

4947 NATCHEZ TRCE
FRESNO TX
77545-0017
US

V. Phone/Fax

Practice location:
  • Phone: 954-292-4407
  • Fax:
Mailing address:
  • Phone: 832-504-1780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number9189
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: