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NPI Code Detail

MEDICARE: DOLORES MCCULLOUGH LMSW

MEDICARE: DOLORES MCCULLOUGH LMSW
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
1104100000XSocial Worker085281NY

General Provider Information

NPI Number : 1518435098
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOLORES MCCULLOUGH LMSW
Provider Business Mailing Address
First Line : 9 W 31ST ST APT 7F
Second Line :
City : NEW YORK
State : NY
Zip : 10001-4507
Country : US
Telephone Number : 347-661-4808
Fax Number :
Provider Business Practice Location Address
First Line : 860 MELROSE AVE STE 2L
Second Line :
City : BRONX
State : NY
Zip : 10451-4443
Country : US
Telephone Number : 917-473-6996
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2018
Last Update Date : 11/02/2018

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Directions to “ DOLORES MCCULLOUGH LMSW” Practice Location

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