Provider Demographics
NPI:1720175482
Name:MULONE, JACQUELINE (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:
Last Name:MULONE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:LOZANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:221 09 43RD AVENUE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2424
Mailing Address - Country:US
Mailing Address - Phone:718-281-0564
Mailing Address - Fax:
Practice Address - Street 1:280 MADISON AVE
Practice Address - Street 2:SUITE 1403
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10046-0001
Practice Address - Country:US
Practice Address - Phone:917-519-5475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0168921103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist