Provider Demographics
NPI:1033788583
Name:MULLIGAN ATTARA, CLARISSA (PHD,LPC,LCADC,LMHC)
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:
Last Name:MULLIGAN ATTARA
Suffix:
Gender:F
Credentials:PHD,LPC,LCADC,LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 VILLAGE CENTER DR UNIT 6722
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2797
Mailing Address - Country:US
Mailing Address - Phone:732-997-0311
Mailing Address - Fax:
Practice Address - Street 1:4 PRINCESS RD STE 208
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2322
Practice Address - Country:US
Practice Address - Phone:856-985-9091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-20
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00333200101YA0400X
NY012853-01101YM0800X
NJ37PC00755200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health