Active NPI
Lorie Mullan
- Clinical Social Worker
- Inwood, WV
National Provider Identifier
1326569583
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- DP00944804
- Practice address
- 119 Sader Dr Ste 4
Inwood, WV 25428-3915 - Phone
- (304) 278-3010
- NPI assigned
- Jun 28, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 0904014782 | VA | |
| Clinical Social Worker | 1041C0700X | DP00944804 | WV | Primary |
Addresses
Primary practice location
119 Sader Dr Ste 4
Inwood, WV 25428-3915
Mailing address
PO Box 92
Inwood, WV 25428-0092
Phone (304) 278-3010
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210909002988 | WV | Practitioner - Clinical Social Worker | 0547666901 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0904014782 | VA | MD | Clinical Social Worker |
| DP00944804 | WV | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Luminous Self PLLC | Clinical | Current | Accepting new patients |
Locations
119 Sader Dr
Ste 4
Inwood, WV 25428
Phone (240) 406-9339
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498608000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731283200000",
"number": "1326569583",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 92",
"city": "INWOOD",
"state": "WV",
"postal_code": "254280092",
"telephone_number": "304-278-3010"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "119 SADER DR STE 4",
"city": "INWOOD",
"state": "WV",
"postal_code": "254283915",
"telephone_number": "304-278-3010"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MULLAN",
"first_name": "LORIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-06-28",
"last_updated": "2024-11-11",
"certification_date": "2024-11-11",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "VA",
"license": "0904014782",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "WV",
"license": "DP00944804",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Inwood, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.