Provider Demographics
NPI:1407273063
Name:MCMULLEN, PAIGE ABBY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PAIGE
Middle Name:ABBY
Last Name:MCMULLEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ERIN STREET EXT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-2671
Mailing Address - Country:US
Mailing Address - Phone:860-575-2354
Mailing Address - Fax:
Practice Address - Street 1:25 ERIN STREET EXT
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-2671
Practice Address - Country:US
Practice Address - Phone:860-575-2354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-20
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0080281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical