1821129354 NPI number — MRS. KAREN MULGRUM LCSW

Table of content: MRS. KAREN MULGRUM LCSW (NPI 1821129354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821129354 NPI number — MRS. KAREN MULGRUM LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MULGRUM
Provider First Name:
KAREN
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821129354
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
48 HIDDEN HARBOR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POINT PLEASANT BORO
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08742-4842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-701-1340
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4122 RTE 516 STE C AND D
Provider Second Line Business Practice Location Address:
STRESS CARE OF NEW JERSEY
Provider Business Practice Location Address City Name:
MATAWAN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-679-4500
Provider Business Practice Location Address Fax Number:
732-679-4549
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  44SC05420000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0029807 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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