Healthcare Provider Details

I. General information

NPI: 1316710890
Provider Name (Legal Business Name): WILLIAM P. MULLOOLY APSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 N 10TH ST STE 100
MILWAUKEE WI
53233-1472
US

IV. Provider business mailing address

1004 N 10TH ST STE 100
MILWAUKEE WI
53233-1472
US

V. Phone/Fax

Practice location:
  • Phone: 414-765-0606
  • Fax:
Mailing address:
  • Phone: 414-765-0606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW610
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: