MEDICARE: RYAN M KULL LICENSED CLINICAL SOCIAL WORK LLC

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	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker	PR061627-1	NY

General Provider Information

NPI Number	:	1487059523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RYAN M KULL LICENSED CLINICAL SOCIAL WORK LLC

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	:	330 W 58TH ST STE 401
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10019-1821
Country	:	US
Telephone Number	:	914-200-4675
Fax Number	:

Authorized Official
Title or Position	:	OWNDER
Name	:	RYAN M KULL
Credential	:	PHD, LCSW
Telephone Number	:	914-200-4675

Provider Enumeration Date	:	10/31/2014
Last Update Date	:	02/10/2026

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