Provider Demographics
NPI:1588212567
Name:CULLEN, NICHOLAS P (LCSW)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:P
Last Name:CULLEN
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 1:15 MID COAST DR
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-6079
Mailing Address - Country:US
Mailing Address - Phone:207-317-3421
Mailing Address - Fax:207-338-2388
Practice Address - Street 1:15 MID COAST DR
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6079
Practice Address - Country:US
Practice Address - Phone:207-317-3421
Practice Address - Fax:207-338-2388
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC204301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical