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General NPI Number Information
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NPI Number | 1295251056
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Entity Type | Individual
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Provider Name | MICHAEL PATRICK MULLANE PHD
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Gender | Male
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Dates
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Enumeration Date | 08/14/2017
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Last Update Date | 05/05/2023
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Provider Practice Location Address
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Address Line | 33 TOWER ST
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City | SOMERVILLE
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State | MA
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Zip | 02143-1426
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Country | US
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Telephone | 617-591-4245
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Fax |
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Provider Business Mailing Address
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Address Line | 33 TOWER ST
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City | SOMERVILLE
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State | MA
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Zip | 02143-1426
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Country | US
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Telephone | 617-591-4245
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 11154
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 3927
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS1836
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License Number State | ME
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 023447
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License Number State | NY
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