Provider Demographics
NPI:1639384811
Name:MULFORD, GREGG LAWRENCE (MA,LMHC)
Entity Type:Individual
Prefix:MR
First Name:GREGG
Middle Name:LAWRENCE
Last Name:MULFORD
Suffix:
Gender:M
Credentials:MA,LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-2843
Mailing Address - Country:US
Mailing Address - Phone:617-465-7170
Mailing Address - Fax:
Practice Address - Street 1:232 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:MARBLEHEAD
Practice Address - State:MA
Practice Address - Zip Code:01945-2843
Practice Address - Country:US
Practice Address - Phone:617-465-7170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4006101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health