Provider Demographics
NPI:1093708083
Name:MULCAHY, EMILY VANBUREN (PSY D)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:VANBUREN
Last Name:MULCAHY
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SHELTER COVE LN
Mailing Address - Street 2:# 249
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29928-1508
Mailing Address - Country:US
Mailing Address - Phone:843-338-9619
Mailing Address - Fax:843-785-3785
Practice Address - Street 1:94 MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-1626
Practice Address - Country:US
Practice Address - Phone:843-338-9619
Practice Address - Fax:843-785-3785
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC000806103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R61966Medicare UPIN