MEDICARE: CULLEN PSYCHOLOGICAL SERVICES, PC

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	103T00000X	Psychologist	PS002808L	PA
2	103TC0700X	Clinical Psychologist	PS002808L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	466239000	OTHER	PA	MAGELLAN BEHAVIORAL HEALT
2	P824454	OTHER	PA	OTHER
3	172351	OTHER	PA	BLUE SHIELD
4	0049406000	OTHER	PA	BLUE CROSS
5	264826200	OTHER	PA	ACS OWCP FECA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841334109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CULLEN PSYCHOLOGICAL SERVICES, PC

Provider Business Mailing Address
First Line	:	80 BRYANT RD
Second Line	:
City	:	TURNERSVILLE
State	:	NJ
Zip	:	08012-1446
Country	:	US
Telephone Number	:	856-228-5390
Fax Number	:	856-228-5390

Provider Business Practice Location Address
First Line	:	9331 OLD BUSTLETON AVE
Second Line	:	SUITE 101
City	:	PHILADELPHIA
State	:	PA
Zip	:	19115-4634
Country	:	US
Telephone Number	:	856-228-5390
Fax Number	:	856-228-5390

Authorized Official
Title or Position	:	PRESIDENT, CLINICAL PSYCHOLOGIST
Name	:	DR. THOMAS J CULLEN JR.
Credential	:	PH.D.
Telephone Number	:	856-228-5390

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	11/20/2009

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