Provider Demographics
NPI:1669594149
Name:MULLEN, JANET R (LCSW)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:R
Last Name:MULLEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 E 22ND ST
Mailing Address - Street 2:SUITE 217
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4977
Mailing Address - Country:US
Mailing Address - Phone:630-963-6522
Mailing Address - Fax:
Practice Address - Street 1:10 E 22ND ST
Practice Address - Street 2:SUITE 217
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4977
Practice Address - Country:US
Practice Address - Phone:630-963-6522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2232290OtherBLUE CROSS AND BLUE SHIEL