Healthcare Provider Details

I. General information

NPI: 1013690643
Provider Name (Legal Business Name): PATRICK CULLEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 MASSACHUSETTS AVE
CAMBRIDGE MA
02139-3309
US

IV. Provider business mailing address

99 WASHINGTON ST UNIT 204
MELROSE MA
02176-6028
US

V. Phone/Fax

Practice location:
  • Phone: 978-500-9570
  • Fax:
Mailing address:
  • Phone: 978-500-9570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10006599
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: