Provider Demographics
NPI:1447871991
Name:MCNULTY, JOANNA BLAIR (LICSW)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:BLAIR
Last Name:MCNULTY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 NORTHGATE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532-2235
Mailing Address - Country:US
Mailing Address - Phone:508-330-5725
Mailing Address - Fax:
Practice Address - Street 1:250 PAWTUCKET BLVD
Practice Address - Street 2:
Practice Address - City:TYNGSBORO
Practice Address - State:MA
Practice Address - Zip Code:01879-2214
Practice Address - Country:US
Practice Address - Phone:978-454-5411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker