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NPI Code Detail

MEDICARE: JOHN MCCULLAGH PHD

MEDICARE: JOHN MCCULLAGH PHD
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
1101YM0800XMental Health Counselor
2103TC1900XCounseling Psychologist023722-01NY

General Provider Information

NPI Number : 1780817916
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN MCCULLAGH PHD
Provider Business Mailing Address
First Line : 145 MORNINGSIDE AVE APT 1D
Second Line :
City : NEW YORK
State : NY
Zip : 10027-4348
Country : US
Telephone Number : 832-866-8115
Fax Number :
Provider Business Practice Location Address
First Line : 3512 QUENTIN RD STE 110
Second Line :
City : BROOKLYN
State : NY
Zip : 11234-4245
Country : US
Telephone Number : 800-275-3243
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2009
Last Update Date : 07/22/2020

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