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General NPI Number Information
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NPI Number | 1447560396
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Entity Type | Individual
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Provider Name | MICHAEL MULQUEEN
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Gender | Male
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Dates
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Enumeration Date | 10/13/2010
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Last Update Date | 08/08/2018
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Provider Practice Location Address
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Address Line | 780 AMERICAN LEGION HWY
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City | ROSLINDALE
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State | MA
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Zip | 02131
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Country | US
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Telephone | 617-469-5565
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Fax |
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Provider Business Mailing Address
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Address Line | 8802 ROCKAWAY BEACH BLVD
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City | ROCKAWAY BEACH
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State | NY
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Zip | 11693-1609
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Country | US
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Telephone |
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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 | 084283
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License Number State | NY
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