Provider Demographics
NPI:1568537660
Name:MULHALL, DENNIS J (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:J
Last Name:MULHALL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:DENNIS
Other - Middle Name:
Other - Last Name:MULHALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSWW
Mailing Address - Street 1:430 W MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702
Mailing Address - Country:US
Mailing Address - Phone:631-587-3010
Mailing Address - Fax:631-587-3010
Practice Address - Street 1:430 W MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702
Practice Address - Country:US
Practice Address - Phone:631-587-3010
Practice Address - Fax:631-587-3010
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0414251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
N2A181Medicare UPIN
N2A181Medicare ID - Type Unspecified