Provider Demographics
NPI:1629277512
Name:CULLINAN, NANCY M (LCSW, CDE)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:M
Last Name:CULLINAN
Suffix:
Gender:F
Credentials:LCSW, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:697 DONALD DR S
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-1622
Mailing Address - Country:US
Mailing Address - Phone:908-231-0358
Mailing Address - Fax:
Practice Address - Street 1:697 DONALD DR S
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-1622
Practice Address - Country:US
Practice Address - Phone:908-231-0358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC003060001041C0700X
NJ792601041S0200X
NJCDE09224107174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No174400000XOther Service ProvidersSpecialist