Provider Demographics
NPI:1184199747
Name:CULLATY-PURVIS, SUSAN MARIA (DNP, PMHNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIA
Last Name:CULLATY-PURVIS
Suffix:
Gender:F
Credentials:DNP, PMHNP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MARIA
Other - Last Name:CULLATY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 MILL ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-1048
Mailing Address - Country:US
Mailing Address - Phone:617-855-2000
Mailing Address - Fax:617-855-3826
Practice Address - Street 1:115 MILL ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-1048
Practice Address - Country:US
Practice Address - Phone:617-855-2000
Practice Address - Fax:617-855-3826
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2283174363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health