Basic Information
| Provider Information | |||||||||
| NPI: | 1831230713 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCMULLEN | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | GEORGE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 MUSKET RD | ||||||||
| Address2: | |||||||||
| City: | SWANSEA | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027775027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089845566 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1061 PLEASANT ST | ||||||||
| Address2: | |||||||||
| City: | NEW BEDFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027406728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089968572 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 106523 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.