Provider Demographics
NPI:1710243753
Name:MULBERRY STREET MANAGEMENT SERVICES
Entity Type:Organization
Organization Name:MULBERRY STREET MANAGEMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PARRUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-291-9066
Mailing Address - Street 1:1097 GREENBAG RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-1532
Mailing Address - Country:US
Mailing Address - Phone:304-291-9066
Mailing Address - Fax:304-291-5698
Practice Address - Street 1:1097 GREENBAG RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-1532
Practice Address - Country:US
Practice Address - Phone:304-291-9066
Practice Address - Fax:304-291-5698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10056362251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management