Provider Demographics
NPI:1023210697
Name:MCMULLAN, STEPHANIE DANIELSON (MSW)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:DANIELSON
Last Name:MCMULLAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:M
Other - Last Name:DANIELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:743 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-3613
Mailing Address - Country:US
Mailing Address - Phone:610-983-9949
Mailing Address - Fax:
Practice Address - Street 1:423 EXTON CMNS
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2451
Practice Address - Country:US
Practice Address - Phone:610-524-2444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0154431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical