Active NPI
Carly Ann Mulloy
- Professional Counselor
- Media, PA
National Provider Identifier
1689400749
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- PC017553
- Practice address
- 100 Yearsley Mill Rd
Media, PA 19063-5593 - Phone
- (484) 227-1439
- NPI assigned
- Sep 13, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | PC017553 | PA | Primary |
Addresses
Primary practice location
100 Yearsley Mill Rd
Media, PA 19063-5593
Mailing address
215 Canford Dr
Broomall, PA 19008-3802
Phone (484) 682-5806
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 2022
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
100 N Academy Ave
Danville, PA 17822-9800
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PC017553 | PA | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Geisinger Clinic | Current | Accepting new patients | |
| Geisinger Clinic | Current | Accepting new patients |
Locations
100 N Academy Ave
Danville, PA 17822
Organizations & group practices 3
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.
-
- Family Medicine Physician
- Danville, PA
- NPI 1366493868
-
- Clinic/Center
- Dunmore, PA
- NPI 1124835608
-
- Diagnostic Radiology Physician
- Danville, PA
- NPI 1558313023
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1726185600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726185600000",
"number": "1689400749",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "215 CANFORD DR",
"city": "BROOMALL",
"state": "PA",
"postal_code": "190083802",
"telephone_number": "484-682-5806"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 YEARSLEY MILL RD",
"city": "MEDIA",
"state": "PA",
"postal_code": "190635593",
"telephone_number": "484-227-1439"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MULLOY",
"first_name": "CARLY",
"middle_name": "ANN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-09-13",
"last_updated": "2024-09-13",
"certification_date": "2024-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "PA",
"license": "PC017553",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Media, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.