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General NPI Number Information
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NPI Number | 1346674165
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Entity Type | Individual
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Provider Name | ELAINE J MCCULLOUGH LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/28/2013
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Last Update Date | 08/28/2013
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Provider Practice Location Address
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Address Line | 300 HARPER DR
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City | MOORESTOWN
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State | NJ
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Zip | 08057-3208
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Country | US
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Telephone | 856-552-1300
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Fax |
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Provider Business Mailing Address
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Address Line | 251 HENDRICKSON AVE
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City | EDGEWATER PARK
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State | NJ
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Zip | 08010-2018
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Country | US
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Telephone | 609-877-2860
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC04853000
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License Number State | NJ
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