Provider Demographics
NPI:1346674165
Name:MCCULLOUGH, ELAINE J (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:J
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LONNIE
Other - Middle Name:
Other - Last Name:MCCULLOUGH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:251 HENDRICKSON AVE
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08010-2018
Mailing Address - Country:US
Mailing Address - Phone:609-877-2860
Mailing Address - Fax:
Practice Address - Street 1:300 HARPER DR
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3208
Practice Address - Country:US
Practice Address - Phone:856-552-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC048530001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical