Provider Demographics
NPI:1659569168
Name:MAMMEN, SUNIL M (LMSW)
Entity Type:Individual
Prefix:MR
First Name:SUNIL
Middle Name:M
Last Name:MAMMEN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:MR
Other - First Name:S
Other - Middle Name:MAMMACHAN
Other - Last Name:MAMMEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15015 W AIRPORT BLVD
Mailing Address - Street 2:APT 611
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-7081
Mailing Address - Country:US
Mailing Address - Phone:281-277-5541
Mailing Address - Fax:
Practice Address - Street 1:15015 W AIRPORT BLVD
Practice Address - Street 2:APT 611
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-7081
Practice Address - Country:US
Practice Address - Phone:281-277-5541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50994104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker