Provider Demographics
NPI:1376035659
Name:MULHAM, KRISTINA ALISE (MSED)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:ALISE
Last Name:MULHAM
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 GENESEE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-1330
Mailing Address - Country:US
Mailing Address - Phone:646-529-0832
Mailing Address - Fax:
Practice Address - Street 1:83 GENESEE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-1330
Practice Address - Country:US
Practice Address - Phone:646-529-0832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-03
Last Update Date:2018-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician