Provider Demographics
NPI:1053870667
Name:MULLIN, BRENNA
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:
Last Name:MULLIN
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 1:68 LANTERN LN UNIT 8
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-4559
Mailing Address - Country:US
Mailing Address - Phone:978-337-2743
Mailing Address - Fax:
Practice Address - Street 1:68 LANTERN LN UNIT 8
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-4559
Practice Address - Country:US
Practice Address - Phone:978-337-2743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst