Provider Demographics
NPI:1124563838
Name:SARA MCCULLAH
Entity Type:Organization
Organization Name:SARA MCCULLAH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:347-785-7078
Mailing Address - Street 1:216A ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-2120
Mailing Address - Country:US
Mailing Address - Phone:347-785-7078
Mailing Address - Fax:
Practice Address - Street 1:506 5TH AVE
Practice Address - Street 2:#4
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4812
Practice Address - Country:US
Practice Address - Phone:347-687-3171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY08499311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0849931OtherLCSW LICENSE NUMBER