Provider Demographics
NPI:1750619102
Name:MULLANE, WILLIAM ANDREW (PHD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ANDREW
Last Name:MULLANE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 W 57TH ST
Mailing Address - Street 2:SUITE 808
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2303
Mailing Address - Country:US
Mailing Address - Phone:347-709-8496
Mailing Address - Fax:978-709-8490
Practice Address - Street 1:119 W 57TH ST
Practice Address - Street 2:SUITE 808
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2303
Practice Address - Country:US
Practice Address - Phone:347-709-8496
Practice Address - Fax:978-709-8490
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-23
Last Update Date:2015-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020028103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0300010OtherMBHP
MA1300881Medicaid