Provider Demographics
NPI:1679144950
Name:MULLEN, MEAGAN E (MA)
Entity type:Individual
Prefix:
First Name:MEAGAN
Middle Name:E
Last Name:MULLEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 HARTFORD TPKE
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4499
Mailing Address - Country:US
Mailing Address - Phone:860-459-0601
Mailing Address - Fax:
Practice Address - Street 1:1100 HARTFORD TPKE
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4499
Practice Address - Country:US
Practice Address - Phone:860-459-0601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health