Provider Demographics
NPI:1306123633
Name:MULLINEUX, FRANK RUFFLEY (CASAC MASTERS)
Entity type:Individual
Prefix:MR
First Name:FRANK
Middle Name:RUFFLEY
Last Name:MULLINEUX
Suffix:
Gender:M
Credentials:CASAC MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1268 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-2312
Mailing Address - Country:US
Mailing Address - Phone:718-981-8117
Mailing Address - Fax:718-981-9344
Practice Address - Street 1:1268 FOREST AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302-2312
Practice Address - Country:US
Practice Address - Phone:718-981-8117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY13216101YA0400X
CALCR390080101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA38CBINOtherHORIZONS MHSA
CA38241OtherHORIZONS OUTPATIENT
CA38241OtherOTHER