Provider Demographics
NPI:1871917427
Name:WILLIAM A MULLANE PSYCHOLOGIST PC
Entity type:Organization
Organization Name:WILLIAM A MULLANE PSYCHOLOGIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLANE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:718-645-1118
Mailing Address - Street 1:29 W. DEVONIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552
Mailing Address - Country:US
Mailing Address - Phone:516-769-5965
Mailing Address - Fax:718-645-1148
Practice Address - Street 1:30 WEST 60TH STREET
Practice Address - Street 2:1R
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023
Practice Address - Country:US
Practice Address - Phone:347-709-8496
Practice Address - Fax:718-645-1148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020028103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty