Provider Demographics
NPI:1326253253
Name:MULLERVY, G. MILES (LICSW)
Entity Type:Individual
Prefix:MR
First Name:G. MILES
Middle Name:
Last Name:MULLERVY
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:MR
Other - First Name:GEORGE
Other - Middle Name:MILES
Other - Last Name:MULLERVY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:33 COLLEGE HILL RD
Mailing Address - Street 2:STE 30E
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2776
Mailing Address - Country:US
Mailing Address - Phone:401-821-6070
Mailing Address - Fax:401-821-6047
Practice Address - Street 1:33 COLLEGE HILL RD
Practice Address - Street 2:STE 30E
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2776
Practice Address - Country:US
Practice Address - Phone:401-821-6070
Practice Address - Fax:401-821-6047
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILSW00149104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
1036550OtherBEACON HEALTH
30449-0OtherBLUE CROSS
GM52559Medicare UPIN
30449-0OtherBLUE CROSS