MEDICARE: EUGENIA MULLENIX LMFT

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
1	103K00000X	Behavior Analyst	1-15-19991	CT
2	106H00000X	Marriage & Family Therapist	001337	CT

General Provider Information

NPI Number	:	1710221593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUGENIA MULLENIX LMFT

Provider Business Mailing Address
First Line	:	1574 NEW HAVEN AVE
Second Line	:
City	:	MILFORD
State	:	CT
Zip	:	06460-8220
Country	:	US
Telephone Number	:	203-308-6429
Fax Number	:

Provider Business Practice Location Address
First Line	:	1574 NEW HAVEN AVE
Second Line	:
City	:	MILFORD
State	:	CT
Zip	:	06460-8220
Country	:	US
Telephone Number	:	203-308-6429
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2012
Last Update Date	:	04/23/2022

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