Provider Demographics
NPI:1881178432
Name:MULLIGAN, GEORGE BERNARD (LICSW)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:BERNARD
Last Name:MULLIGAN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12801 OLD COLUMBIA PIKE APT 123
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-5255
Mailing Address - Country:US
Mailing Address - Phone:817-239-0749
Mailing Address - Fax:
Practice Address - Street 1:8901 NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-3611
Practice Address - Country:US
Practice Address - Phone:301-445-7970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1145961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty