Provider Demographics
NPI:1780720292
Name:MUMLEY, DENISE L (PHD)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:L
Last Name:MUMLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 BELMONT ST
Mailing Address - Street 2:WSH - FORENSIC SERVICE
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-1681
Mailing Address - Country:US
Mailing Address - Phone:508-368-3440
Mailing Address - Fax:508-363-1506
Practice Address - Street 1:305 BELMONT ST
Practice Address - Street 2:WSH - FORENSIC SERVICE
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-1681
Practice Address - Country:US
Practice Address - Phone:508-368-3440
Practice Address - Fax:508-363-1506
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7686103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic