Doctor Name: | PAMELA MULREADY |
NPI Number: | 1023373248 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC, LADC |
License Number: | 001054 |
Business Practice Address: | 122a Naubuc Ave Glastonbury, CT - 060334246 |
Business Phone Number: | 8602180948 |
Business Fax Number: | |
Mailing Address: | 122a Naubuc Ave, Suite 210 GLASTONBURY |
State: | CT |
Postal Code: | 060334246 |
Phone Number: | 8602180948 |
Fax Number: | |
NPI Enumeration Date: | 07/13/2012 |
NPI Last Update Date: | 10/07/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 001054 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |