Provider Demographics
NPI:1982349072
Name:MCMULLEN, OWEN CHARLES, SERGEY
Entity Type:Individual
Prefix:
First Name:OWEN
Middle Name:CHARLES, SERGEY
Last Name:MCMULLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 JUNIPER RD
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-1630
Mailing Address - Country:US
Mailing Address - Phone:978-559-9067
Mailing Address - Fax:
Practice Address - Street 1:3 BLACKBURN CTR
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-2268
Practice Address - Country:US
Practice Address - Phone:978-283-7198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor