Healthcare Provider Details

I. General information

NPI: 1497129100
Provider Name (Legal Business Name): CHRISTINA M MULE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2015
Last Update Date: 07/03/2023
Certification Date: 03/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E RIVER RD
ROCHESTER NY
14623-1212
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 671
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-2986
  • Fax: 585-275-3366
Mailing address:
  • Phone: 585-275-2986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number10172
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number23587
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number438142
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number023587
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: