Provider Demographics
NPI:1740204650
Name:MULLICAN, ROBIN
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:MULLICAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6234
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-6234
Mailing Address - Country:US
Mailing Address - Phone:443-847-0100
Mailing Address - Fax:
Practice Address - Street 1:6851 OAK HALL LN
Practice Address - Street 2:SUITE 118
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5846
Practice Address - Country:US
Practice Address - Phone:443-847-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04066103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD132190100Medicaid
MD211819Medicare Oscar/Certification
MDQ24587Medicare UPIN
MD132190100Medicaid