Provider Demographics
NPI:1356641526
Name:CULLEN, SHANNON CATHERINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:CATHERINE
Last Name:CULLEN
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 1:4554 39TH PL APT 4A
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-3515
Mailing Address - Country:US
Mailing Address - Phone:516-659-9482
Mailing Address - Fax:
Practice Address - Street 1:26 W 9TH ST APT 3D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8923
Practice Address - Country:US
Practice Address - Phone:516-659-9482
Practice Address - Fax:516-659-9482
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72078091104100000X
NY0816491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker