MEDICARE: DR. RYAN M KULL PHD, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	R061627-1	NY

General Provider Information

NPI Number	:	1346447844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN M KULL PHD, LCSW

Provider Business Mailing Address
First Line	:	83 S OCEAN AVE UNIT 500
Second Line	:
City	:	PATCHOGUE
State	:	NY
Zip	:	11772-3702
Country	:	US
Telephone Number	:	914-200-4675
Fax Number	:

Provider Business Practice Location Address
First Line	:	363 7TH AVE FL 21
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-3904
Country	:	US
Telephone Number	:	917-991-8417
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2007
Last Update Date	:	02/13/2026

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