Provider Demographics
NPI:1326188251
Name:MULVEY, CORY LEE (MA, LMHC)
Entity Type:Individual
Prefix:MS
First Name:CORY
Middle Name:LEE
Last Name:MULVEY
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 KENWOOD CT
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01543-1532
Mailing Address - Country:US
Mailing Address - Phone:508-767-3016
Mailing Address - Fax:
Practice Address - Street 1:286 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2106
Practice Address - Country:US
Practice Address - Phone:508-767-3016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6093101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health