Provider Demographics
NPI:1629172200
Name:MACMULLEN, ERIN
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:MACMULLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:DURETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:109 RHODE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-1370
Mailing Address - Country:US
Mailing Address - Phone:781-489-5717
Mailing Address - Fax:508-819-3035
Practice Address - Street 1:7 ESSEX GREAN DRIVE
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01880-5022
Practice Address - Country:US
Practice Address - Phone:781-224-1416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA729231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5104343Medicaid
MAMA030064Medicare PIN