Provider Demographics
NPI:1265765994
Name:MULLIGAN, RAYMOND DAVID (PSYD, MBA)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:DAVID
Last Name:MULLIGAN
Suffix:
Gender:M
Credentials:PSYD, MBA
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Mailing Address - Street 1:431 SNOWY EGRET LANE
Mailing Address - Street 2:R D MULLIGAN, LLC
Mailing Address - City:KIAWAH ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455
Mailing Address - Country:US
Mailing Address - Phone:610-216-4736
Mailing Address - Fax:610-867-5003
Practice Address - Street 1:431 SNOWY EGRET LANE
Practice Address - Street 2:
Practice Address - City:KIAWAH ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455
Practice Address - Country:US
Practice Address - Phone:610-216-4736
Practice Address - Fax:610-867-5003
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC1356103T00000X
PAPS016669103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA12013691OtherCAQH