Provider Demographics
NPI:1285363432
Name:KATHLEEN MCNULTY PHD, LLC
Entity type:Organization
Organization Name:KATHLEEN MCNULTY PHD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNULTY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:551-580-0571
Mailing Address - Street 1:24 GODWIN AVE STE 1-6
Mailing Address - Street 2:
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432-1927
Mailing Address - Country:US
Mailing Address - Phone:201-299-4001
Mailing Address - Fax:941-916-9902
Practice Address - Street 1:24 GODWIN AVE STE 1-6
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1927
Practice Address - Country:US
Practice Address - Phone:201-299-4001
Practice Address - Fax:941-916-9902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-05
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
103T00000XOtherPHD