Provider Demographics
NPI:1093231573
Name:CULLEN, KATHERINE E
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:E
Last Name:CULLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:SCHREIBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2207 LULU LIZZY LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-2760
Mailing Address - Country:US
Mailing Address - Phone:929-247-9234
Mailing Address - Fax:
Practice Address - Street 1:2207 LULU LIZZY LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932-2760
Practice Address - Country:US
Practice Address - Phone:929-247-9234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.0135624TELE1041C0700X
TN90661041C0700X
NY0959371041C0700X
PACW0244701041C0700X
171M00000X
MEMC21997104100000X
NY108024104100000X
PASW140201104100000X
NCC0163871041C0700X
MELC228611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker