Healthcare Provider Details

I. General information

NPI: 1548033269
Provider Name (Legal Business Name): MELISSA MULQUEEN MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2023
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CENTERVILLE RD STE 103
WARWICK RI
02886-0200
US

IV. Provider business mailing address

243 SUMNER AVE
WARWICK RI
02888-1926
US

V. Phone/Fax

Practice location:
  • Phone: 401-294-0451
  • Fax:
Mailing address:
  • Phone: 860-391-1012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: