Provider Demographics
NPI:1871727362
Name:MULROONEY, AMY LYNNE (LPC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNNE
Last Name:MULROONEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 QUEEN ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-1234
Mailing Address - Country:US
Mailing Address - Phone:860-479-1735
Mailing Address - Fax:
Practice Address - Street 1:943 QUEEN ST FL 2
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-1234
Practice Address - Country:US
Practice Address - Phone:860-479-1735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001730101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional