Provider Demographics
NPI:1962016287
Name:MULLEN, DOREEN L (LGSW)
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:L
Last Name:MULLEN
Suffix:
Gender:F
Credentials:LGSW
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 763
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-0763
Mailing Address - Country:US
Mailing Address - Phone:240-237-8716
Mailing Address - Fax:
Practice Address - Street 1:65 DUKE ST # 203
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-6128
Practice Address - Country:US
Practice Address - Phone:240-237-8716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24195104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker