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General NPI Number Information
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NPI Number | 1114187267
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Entity Type | Individual
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Provider Name | EDWARD DAVID MULLIGAN III LCSW
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Gender | Male
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Dates
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Enumeration Date | 06/12/2008
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 2315 FLORIDA STREET BLDG 200, SUITE 226
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City | MANDEVILLE
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State | LA
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Zip | 70448
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Country | US
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Telephone | 985-774-0175
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Fax | 985-377-0980
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Provider Business Mailing Address
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Address Line | 1901 HIGHWAY 190 APT 1323
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City | MANDEVILLE
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State | LA
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Zip | 70448-3486
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Country | US
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Telephone | 985-774-0175
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Fax | 985-377-0980
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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 | 6610
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License Number State | LA
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