Healthcare Provider Details

I. General information

NPI: 1003844234
Provider Name (Legal Business Name): JOHN MATTHEW MULKERN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 MERRIMACK ST SUITE 200
LOWELL MA
01852-1729
US

IV. Provider business mailing address

45 MERRIMACK ST SUITE200
LOWELL MA
01852-1729
US

V. Phone/Fax

Practice location:
  • Phone: 978-459-2306
  • Fax: 978-453-9394
Mailing address:
  • Phone: 978-459-2306
  • Fax: 978-453-9394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number205413
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: