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NPI Code Detail

MEDICARE: MARY ANN MULLIN PH. D.

MEDICARE: MARY ANN MULLIN PH. D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist4733MA

General Provider Information

NPI Number : 1588661557
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY ANN MULLIN PH. D.
Provider Business Mailing Address
First Line : 128 COOLIDGE ST
Second Line :
City : BROOKLINE
State : MA
Zip : 02446-5808
Country : US
Telephone Number : 617-254-3800
Fax Number : 617-779-1262
Provider Business Practice Location Address
First Line : 30 WARREN ST
Second Line :
City : BRIGHTON
State : MA
Zip : 02135-3602
Country : US
Telephone Number : 617-254-3800
Fax Number : 617-779-1262
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2005
Last Update Date : 07/08/2007

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