1841334109 NPI number — CULLEN PSYCHOLOGICAL SERVICES, PC

Table of content: (NPI 1841334109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841334109 NPI number — CULLEN PSYCHOLOGICAL SERVICES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CULLEN PSYCHOLOGICAL SERVICES, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THOMAS J. CULLEN, JR., PH.D.
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841334109
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
80 BRYANT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TURNERSVILLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08012-1446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-228-5390
Provider Business Mailing Address Fax Number:
856-228-5390

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9331 OLD BUSTLETON AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19115-4634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-228-5390
Provider Business Practice Location Address Fax Number:
856-228-5390
Provider Enumeration Date:
02/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CULLEN
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT, CLINICAL PSYCHOLOGIST
Authorized Official Telephone Number:
856-228-5390

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PS002808L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: PS002808L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 466239000 . This is a "MAGELLAN BEHAVIORAL HEALT" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P824454 . This is a "OTHER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 172351 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0049406000 . This is a "BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 264826200 . This is a "ACS OWCP FECA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7579734 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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