Provider Demographics
NPI:1134873128
Name:MULLIGAN, MARY ELLEN (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY ELLEN
Middle Name:
Last Name:MULLIGAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 REGENCY DR
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-1154
Mailing Address - Country:US
Mailing Address - Phone:917-282-8076
Mailing Address - Fax:
Practice Address - Street 1:24 REGENCY DR
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-1154
Practice Address - Country:US
Practice Address - Phone:917-282-8076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019327-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical