Healthcare Provider Details

I. General information

NPI: 1922087634
Provider Name (Legal Business Name): DUANE D. CULLER LISW, CGC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 05/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20600 CHAGRIN BLVD SUITE 7500
SHAKER HEIGHTS OH
44122-5327
US

IV. Provider business mailing address

16065 GLYNN RD
E CLEVELAND OH
44112-3534
US

V. Phone/Fax

Practice location:
  • Phone: 216-761-4861
  • Fax: 216-844-7497
Mailing address:
  • Phone: 216-761-4861
  • Fax: 216-844-7497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1201591
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: