Healthcare Provider Details

I. General information

NPI: 1386110120
Provider Name (Legal Business Name): SONDRA CULLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SONDRA MCADAM

II. Dates (important events)

Enumeration Date: 10/19/2018
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 OLD MILFORD RD
BROOKLINE NH
03033
US

IV. Provider business mailing address

93 OLD MILFORD RD
BROOKLINE NH
03033
US

V. Phone/Fax

Practice location:
  • Phone: 203-331-7026
  • Fax:
Mailing address:
  • Phone: 203-331-7026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number256
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: