Provider Demographics
NPI:1366261026
Name:MCMULLAN, YESSICA
Entity type:Individual
Prefix:
First Name:YESSICA
Middle Name:
Last Name:MCMULLAN
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 1:307 E 44TH ST APT 1207
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-4442
Mailing Address - Country:US
Mailing Address - Phone:917-302-6759
Mailing Address - Fax:
Practice Address - Street 1:307 E 44TH ST APT 1207
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-4442
Practice Address - Country:US
Practice Address - Phone:917-302-6759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015199101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor