| Kathleen Mcnulty Phd, Llc | |
|
24 Godwin Ave Ste 1-6 Midland Park NJ 07432-1927 | |
| (201) 299-4001 | |
| (941) 916-9902 |
| Full Name | Kathleen Mcnulty Phd, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 24 Godwin Ave Ste 1-6, Midland Park, New Jersey |
| Authorized Official Name and Position | Kathleen Mcnulty (OWNER) |
| Authorized Official Contact | 5515800571 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kathleen Mcnulty Phd, Llc 24 Godwin Ave Ste 1-6 Midland Park NJ 07432-1927 Ph: (201) 299-4001 | Kathleen Mcnulty Phd, Llc 24 Godwin Ave Ste 1-6 Midland Park NJ 07432-1927 Ph: (201) 299-4001 |
| NPI Number | 1285363432 |
|---|---|
| Provider Enumeration Date | 06/05/2022 |
| Last Update Date | 01/23/2023 |
| Certification Date | 01/23/2023 |
| Medicare PECOS PAC ID | 3779958145 |
|---|---|
| Medicare Enrollment ID | O20230417002687 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285363432 | NPI | - | NPPES |
| 103T00000X | Other | PHD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Kathleen Mcnulty |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1770619066 PECOS PAC ID: 7012954563 Enrollment ID: I20170601000928 |
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