Provider Demographics
NPI:1598994592
Name:MULCAHY, JOANN KATHLEEN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:KATHLEEN
Last Name:MULCAHY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 NIMHAM RD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-3639
Mailing Address - Country:US
Mailing Address - Phone:914-804-0850
Mailing Address - Fax:845-225-0346
Practice Address - Street 1:411 NIMHAM RD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-3639
Practice Address - Country:US
Practice Address - Phone:914-804-0850
Practice Address - Fax:845-225-0346
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYAA580076172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker