MEDICARE: JEFFREY R CULLERS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	087495	NY
2	1041C0700X	Clinical Social Worker	CW016065	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	087495	OTHER	NY	NY STATE LICENSE

General Provider Information

NPI Number	:	1104075720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY R CULLERS LCSW

Provider Business Mailing Address
First Line	:	41491 ROUTE 6
Second Line	:
City	:	COLUMBUS
State	:	PA
Zip	:	16405-2805
Country	:	US
Telephone Number	:	814-440-4526
Fax Number	:

Provider Business Practice Location Address
First Line	:	41491 ROUTE 6
Second Line	:
City	:	COLUMBUS
State	:	PA
Zip	:	16405-2805
Country	:	US
Telephone Number	:	814-440-4526
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2008
Last Update Date	:	01/22/2019

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