Provider Demographics
NPI:1922218080
Name:MULLALY, ROBERT WILLIAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:MULLALY
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 1:40 SOUTH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-3282
Mailing Address - Country:US
Mailing Address - Phone:781-631-2114
Mailing Address - Fax:781-639-0100
Practice Address - Street 1:40 SOUTH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:MARBLEHEAD
Practice Address - State:MA
Practice Address - Zip Code:01945-3282
Practice Address - Country:US
Practice Address - Phone:781-631-2114
Practice Address - Fax:781-639-0100
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3310103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical