Provider Demographics
NPI:1962655316
Name:MORGAN-MULLANE, ANNA KATHLEEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:KATHLEEN
Last Name:MORGAN-MULLANE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:MORGAN MULLANE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:54 MACDONOUGH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-2304
Mailing Address - Country:US
Mailing Address - Phone:718-483-9290
Mailing Address - Fax:718-483-9287
Practice Address - Street 1:54 MACDONOUGH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-2304
Practice Address - Country:US
Practice Address - Phone:718-483-9290
Practice Address - Fax:718-483-9287
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081818-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03505424Medicaid