Provider Demographics
NPI:1326590647
Name:ROBIN J MULLICAN, PSYD, LLC
Entity Type:Organization
Organization Name:ROBIN J MULLICAN, PSYD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MULLICAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:443-847-0100
Mailing Address - Street 1:PO BOX 6234
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-6234
Mailing Address - Country:US
Mailing Address - Phone:443-847-0100
Mailing Address - Fax:
Practice Address - Street 1:6851 OAK HALL LN
Practice Address - Street 2:SUITE 118
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5846
Practice Address - Country:US
Practice Address - Phone:443-847-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04066103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty