Healthcare Provider Details

I. General information

NPI: 1184199747
Provider Name (Legal Business Name): SUSAN MARIA CULLATY-PURVIS DNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN MARIA CULLATY

II. Dates (important events)

Enumeration Date: 10/10/2018
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 MILL ST
BELMONT MA
02478-1048
US

IV. Provider business mailing address

115 MILL ST
BELMONT MA
02478-1048
US

V. Phone/Fax

Practice location:
  • Phone: 617-855-2000
  • Fax: 617-855-3826
Mailing address:
  • Phone: 617-855-2000
  • Fax: 617-855-3826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2283174
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: