Provider Demographics
NPI:1588713309
Name:MULLIN, WILLIAM PATRICK (LCSW-R, CT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PATRICK
Last Name:MULLIN
Suffix:
Gender:M
Credentials:LCSW-R, CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 TABER LN
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5824
Mailing Address - Country:US
Mailing Address - Phone:315-272-6487
Mailing Address - Fax:315-272-6487
Practice Address - Street 1:501 N JAMES ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-4215
Practice Address - Country:US
Practice Address - Phone:315-334-5488
Practice Address - Fax:315-334-5488
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR053867-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical