Provider Demographics
NPI:1881856961
Name:MULLEN, GINA (LICSW)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:MULLEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 HARTFORD AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-3224
Mailing Address - Country:US
Mailing Address - Phone:401-273-8100
Mailing Address - Fax:401-861-8696
Practice Address - Street 1:1443 HARTFORD AVENUE
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919
Practice Address - Country:US
Practice Address - Phone:401-273-8100
Practice Address - Fax:401-861-8696
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILCDP00421101YA0400X
RIISW023571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)