Provider Demographics
NPI:1689900110
Name:MULLARKEY, BRIDGET (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:MULLARKEY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3091 37TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3808
Mailing Address - Country:US
Mailing Address - Phone:347-213-4304
Mailing Address - Fax:
Practice Address - Street 1:3091 37TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3808
Practice Address - Country:US
Practice Address - Phone:347-213-4304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-18
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013082-1253Z00000X, 252Y00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No253Z00000XAgenciesIn Home Supportive Care
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1558872523Medicaid