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General NPI Number Information
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NPI Number | 1104888569
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Entity Type | Individual
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Provider Name | LOUISE GOTTLOB CULLEN LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/03/2006
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 35000 CHARDON RD #210 DIANE EDEN MD AND ASSOC.
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City | WILLOUGHBY HILLS
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State | OH
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Zip | 44094
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Country | US
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Telephone | 440-951-5600
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Fax | 440-951-1293
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Provider Business Mailing Address
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Address Line | 35000 CHARDON RD #210 DIANE EDEN MD AND ASSOC.
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City | WILLOUGHBY HILLS
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State | OH
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Zip | 44094
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Country | US
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Telephone | 440-951-5600
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Fax | 440-951-1293
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 7128
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LISW-19236
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License Number State | AZ
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