Provider Demographics
NPI:1275264475
Name:MULLEN, SPENCER (LAC)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:MULLEN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 UNION AVE # 1
Mailing Address - Street 2:
Mailing Address - City:MIDDLESEX
Mailing Address - State:NJ
Mailing Address - Zip Code:08846-1039
Mailing Address - Country:US
Mailing Address - Phone:732-893-2000
Mailing Address - Fax:
Practice Address - Street 1:127 UNION AVE # 1
Practice Address - Street 2:
Practice Address - City:MIDDLESEX
Practice Address - State:NJ
Practice Address - Zip Code:08846-1039
Practice Address - Country:US
Practice Address - Phone:732-893-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00562700101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)