Healthcare Provider Details

I. General information

NPI: 1326188681
Provider Name (Legal Business Name): BRIGID KATHERINE MULLIN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 OAK ST
COPIAGUE NY
11726-3111
US

IV. Provider business mailing address

118 MAPLE BLVD
LONG BEACH NY
11561-3817
US

V. Phone/Fax

Practice location:
  • Phone: 631-691-7080
  • Fax: 631-691-3387
Mailing address:
  • Phone: 516-840-5117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number72074690
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: