Provider Demographics
NPI:1851449094
Name:MULLIN, WALTER J (PHD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:J
Last Name:MULLIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 N PLEASANT ST STE 207
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-1741
Mailing Address - Country:US
Mailing Address - Phone:413-461-4042
Mailing Address - Fax:413-726-6001
Practice Address - Street 1:48 N PLEASANT ST STE 207
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-1741
Practice Address - Country:US
Practice Address - Phone:413-461-4042
Practice Address - Fax:413-726-6001
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1040641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA400430OtherMAGELLAN
MAP02205OtherBLUE CROSS BLUE SHIELD
MAP20712Medicare ID - Type Unspecified