Provider Demographics
NPI:1982301131
Name:MCNULTY, CATHERINE (PHD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:MCNULTY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 REVERE PL
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4714
Mailing Address - Country:US
Mailing Address - Phone:203-451-4625
Mailing Address - Fax:
Practice Address - Street 1:25 VALLEY DR STE 2B
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831-5203
Practice Address - Country:US
Practice Address - Phone:203-501-3034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017477103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical