Provider Demographics
NPI:1174668719
Name:MCMULLEN, DONNA-LEE (LICSW)
Entity Type:Individual
Prefix:
First Name:DONNA-LEE
Middle Name:
Last Name:MCMULLEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 494
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-0494
Mailing Address - Country:US
Mailing Address - Phone:508-539-0221
Mailing Address - Fax:508-539-0221
Practice Address - Street 1:2 OAK STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649
Practice Address - Country:US
Practice Address - Phone:508-539-0221
Practice Address - Fax:508-539-0221
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110669101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MADO P23677Medicare ID - Type UnspecifiedPARTICIPATING PROVIDER