Provider Demographics
NPI:1295768489
Name:MCNULTY, FRANCINE M (RN, PCC, LSW, LICDC)
Entity type:Individual
Prefix:
First Name:FRANCINE
Middle Name:M
Last Name:MCNULTY
Suffix:
Gender:F
Credentials:RN, PCC, LSW, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1646 CRESTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-3333
Mailing Address - Country:US
Mailing Address - Phone:440-781-4546
Mailing Address - Fax:440-461-1672
Practice Address - Street 1:1450 SOM CENTER RD STE 20
Practice Address - Street 2:
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2117
Practice Address - Country:US
Practice Address - Phone:440-781-4546
Practice Address - Fax:440-461-1672
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH981014101YA0400X
OHE0003566101YM0800X
OHS0015246104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker