Healthcare Provider Details

I. General information

NPI: 1689900110
Provider Name (Legal Business Name): BRIDGET MULLARKEY M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2009
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3091 37TH ST
ASTORIA NY
11103-3808
US

IV. Provider business mailing address

3091 37TH ST
ASTORIA NY
11103-3808
US

V. Phone/Fax

Practice location:
  • Phone: 347-213-4304
  • Fax:
Mailing address:
  • Phone: 347-213-4304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number013082-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number013082-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number013082-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: