MEDICARE: CHRISTOPHER MULLIGAN LCSW

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	104100000X	Social Worker	LCS18188	CA

General Provider Information

NPI Number	:	1942561741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER MULLIGAN LCSW

Provider Business Mailing Address
First Line	:	3685 MOTOR AVE STE 150
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-7203
Country	:	US
Telephone Number	:	310-287-1640
Fax Number	:	310-287-0851

Provider Business Practice Location Address
First Line	:	3685 MOTOR AVE
Second Line	:	SUITE 150
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-5750
Country	:	US
Telephone Number	:	310-287-1640
Fax Number	:	310-287-0851

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

Provider Enumeration Date	:	06/07/2012
Last Update Date	:	06/07/2012

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