Provider Demographics
NPI:1275661043
Name:KULICK, DAVID MICHAEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MICHAEL
Last Name:KULICK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6180 RIVERSIDE DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-4536
Mailing Address - Country:US
Mailing Address - Phone:909-590-5355
Mailing Address - Fax:909-590-5333
Practice Address - Street 1:6180 RIVERSIDE DR
Practice Address - Street 2:SUITE H
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4536
Practice Address - Country:US
Practice Address - Phone:909-590-5355
Practice Address - Fax:909-590-5333
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 186581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical