Provider Demographics
NPI:1477729085
Name:MULLIN, COLLEEN MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:MARIE
Last Name:MULLIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:COLLEEN
Other - Middle Name:MARIE
Other - Last Name:HICKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:120 MEADOW ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-6615
Mailing Address - Country:US
Mailing Address - Phone:201-694-0897
Mailing Address - Fax:201-694-0897
Practice Address - Street 1:120 MEADOW ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-6615
Practice Address - Country:US
Practice Address - Phone:201-694-0897
Practice Address - Fax:201-694-0897
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-03
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051785001041C0700X
NY078503-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical