Provider Demographics
NPI:1134471220
Name:CULLOM, BRENDA MARSHA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:MARSHA
Last Name:CULLOM
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 1:53 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-3470
Mailing Address - Country:US
Mailing Address - Phone:203-988-6549
Mailing Address - Fax:
Practice Address - Street 1:157 GOOSE LN
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2100
Practice Address - Country:US
Practice Address - Phone:203-988-6549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0031951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical