Provider Demographics
NPI:1093112781
Name:MULLINGS, MICHELLE KIMONE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:KIMONE
Last Name:MULLINGS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14228 129TH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11436-1719
Mailing Address - Country:US
Mailing Address - Phone:347-678-1568
Mailing Address - Fax:
Practice Address - Street 1:8956 162ND ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5072
Practice Address - Country:US
Practice Address - Phone:718-657-7100
Practice Address - Fax:718-657-7137
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72081420104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker