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General NPI Number Information
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NPI Number | 1063990604
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Entity Type | Individual
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Provider Name | LIAM MULLIGAN LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/06/2018
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Last Update Date | 07/17/2019
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Provider Practice Location Address
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Address Line | 833 CHESTNUT ST STE 210
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City | PHILADELPHIA
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State | PA
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Zip | 19107-4405
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Country | US
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Telephone | 215-955-8962
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Fax |
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Provider Business Mailing Address
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Address Line | 2130 SPRING GARDEN ST
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City | PHILADELPHIA
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State | PA
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Zip | 19130-3502
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Country | US
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Telephone | 215-955-9555
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05597500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW018559
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License Number State | PA
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