| Doctor Name: | MRS. ROBERTA JACQUELINE MULLAN |
| NPI Number: | 1376659342 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LADC |
| License Number: | LC1420 |
| Business Practice Address: | 256 Cressey Rd Monmouth, ME - 042596804 |
| Business Phone Number: | 2079334092 |
| Business Fax Number: | |
| Mailing Address: | 256 Cressey Rd, MONMOUTH |
| State: | ME |
| Postal Code: | 042596804 |
| Phone Number: | 2079334092 |
| Fax Number: | |
| NPI Enumeration Date: | 08/22/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | LC1420 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ME |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |