Provider Demographics
NPI:1942047089
Name:MULLANEY, MADISON
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:MULLANEY
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 1:39 MILLYARD UNIT 201
Mailing Address - Street 2:
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-2437
Mailing Address - Country:US
Mailing Address - Phone:508-404-4626
Mailing Address - Fax:
Practice Address - Street 1:100 CUMMINGS CTR STE 158D
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6279
Practice Address - Country:US
Practice Address - Phone:978-907-4801
Practice Address - Fax:978-921-2982
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist