Provider Demographics
NPI:1952915134
Name:MULVANEY, LAURIE ANN
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANN
Last Name:MULVANEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-8938
Mailing Address - Country:US
Mailing Address - Phone:845-856-4796
Mailing Address - Fax:
Practice Address - Street 1:20093 OFFICE CIR UNIT 207
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-3196
Practice Address - Country:US
Practice Address - Phone:302-856-9746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ3-0000287104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker