Provider Demographics
NPI:1124697321
Name:HIDALGO MULGREW, KELSEY REBECCA
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:REBECCA
Last Name:HIDALGO MULGREW
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 1:1819 24TH ST NE APT 101
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-1922
Mailing Address - Country:US
Mailing Address - Phone:973-902-6548
Mailing Address - Fax:
Practice Address - Street 1:1819 24TH ST NE APT 101
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1922
Practice Address - Country:US
Practice Address - Phone:973-902-6548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician