Healthcare Provider Details

I. General information

NPI: 1386907020
Provider Name (Legal Business Name): EMMA ROSSITER-CULLEN MCCULLOCH PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 A SHATTUCK AVE STE. 201
BERKELEY CA
94709
US

IV. Provider business mailing address

1521 A SHATTUCK AVE STE. 201
BERKELEY CA
94709
US

V. Phone/Fax

Practice location:
  • Phone: 707-509-3603
  • Fax:
Mailing address:
  • Phone: 707-509-3603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY33072
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: