Provider Demographics
NPI:1093791162
Name:CULLEN, PAMELA M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:M
Last Name:CULLEN
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 1:305 ROSEBERRY ST
Mailing Address - Street 2:SUITE8
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1600
Mailing Address - Country:US
Mailing Address - Phone:908-454-7244
Mailing Address - Fax:908-859-2109
Practice Address - Street 1:305 ROSEBERRY ST
Practice Address - Street 2:SUITE8
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1600
Practice Address - Country:US
Practice Address - Phone:908-454-7244
Practice Address - Fax:908-859-2109
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC003535001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2457488000OtherAMERIHEALTH