Provider Demographics
NPI:1376582106
Name:MCNULTY, BRIAN F (MS)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:F
Last Name:MCNULTY
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 WASHINGTON ST STE 310
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3481
Mailing Address - Country:US
Mailing Address - Phone:781-769-8910
Mailing Address - Fax:781-255-9844
Practice Address - Street 1:825 WASHINGTON ST STE 310
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3481
Practice Address - Country:US
Practice Address - Phone:781-769-8910
Practice Address - Fax:781-255-9844
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA632231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA04516402OtherPTAN