Provider Demographics
NPI:1356764401
Name:CULLERS, JOSEPH (LSW)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:CULLERS
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 CREEKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:SPRING CREEK
Mailing Address - State:PA
Mailing Address - Zip Code:16436-2608
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:809 W 26TH ST STE 2
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-3205
Practice Address - Country:US
Practice Address - Phone:814-461-1192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW130723104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1029743370001Medicaid