Provider Demographics
NPI:1558603365
Name:RD MULLIGAN LLC
Entity Type:Organization
Organization Name:RD MULLIGAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:D
Authorized Official - Last Name:MULLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:610-867-5003
Mailing Address - Street 1:1 W BROAD ST
Mailing Address - Street 2:SUITE 408
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-5717
Mailing Address - Country:US
Mailing Address - Phone:610-867-5001
Mailing Address - Fax:610-867-5003
Practice Address - Street 1:1 W BROAD ST
Practice Address - Street 2:SUITE 408
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5717
Practice Address - Country:US
Practice Address - Phone:610-867-5001
Practice Address - Fax:610-867-5003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016669103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty