Healthcare Provider Details

I. General information

NPI: 1487701751
Provider Name (Legal Business Name): JOSEPH MULLEN LCSW-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W UNIVERSITY PKWY STE 1J
BALTIMORE MD
21210-3235
US

IV. Provider business mailing address

245 W LANVALE ST
BALTIMORE MD
21217-4124
US

V. Phone/Fax

Practice location:
  • Phone: 410-889-1122
  • Fax:
Mailing address:
  • Phone: 410-889-1122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number996
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: