Provider Demographics
NPI:1821299348
Name:EMILY VAN BUREN MULCAHY PSYD
Entity Type:Organization
Organization Name:EMILY VAN BUREN MULCAHY PSYD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:VAN BUREN
Authorized Official - Last Name:MULCAHY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:843-338-9619
Mailing Address - Street 1:2 SHELTER COVE LN
Mailing Address - Street 2:#249
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29928-1512
Mailing Address - Country:US
Mailing Address - Phone:843-338-9619
Mailing Address - Fax:
Practice Address - Street 1:94A MAIN ST
Practice Address - Street 2:
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-1685
Practice Address - Country:US
Practice Address - Phone:843-338-9619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC000806103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
R61966Medicare UPIN