Provider Demographics
NPI:1083708788
Name:KULBERG, VICKI (LCSW)
Entity Type:Individual
Prefix:MR
First Name:VICKI
Middle Name:
Last Name:KULBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 W#. BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11514
Mailing Address - Country:US
Mailing Address - Phone:516-897-1888
Mailing Address - Fax:
Practice Address - Street 1:1 OLD COUNTRY ROAD
Practice Address - Street 2:SUITE 295
Practice Address - City:CARLE PLACE
Practice Address - State:NY
Practice Address - Zip Code:11514
Practice Address - Country:US
Practice Address - Phone:516-739-0957
Practice Address - Fax:516-741-5683
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO432201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN4A861Medicare ID - Type UnspecifiedSOCIAL WORK