Provider Demographics
NPI:1093446510
Name:MULLIN, TATIANA PAMPONET
Entity Type:Individual
Prefix:MRS
First Name:TATIANA
Middle Name:PAMPONET
Last Name:MULLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 KENTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3108
Mailing Address - Country:US
Mailing Address - Phone:848-220-6724
Mailing Address - Fax:
Practice Address - Street 1:4 KENTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3108
Practice Address - Country:US
Practice Address - Phone:848-220-6724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst