Provider Demographics
NPI:1871721233
Name:MULLEN, PATRICK RICHARD (LCSW)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:RICHARD
Last Name:MULLEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6924 STNSTHRW CIR N
Mailing Address - Street 2:SUITE 8305
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-8736
Mailing Address - Country:US
Mailing Address - Phone:727-686-7155
Mailing Address - Fax:727-726-6862
Practice Address - Street 1:3108 58TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33714-1331
Practice Address - Country:US
Practice Address - Phone:727-742-2722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW88281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical