Provider Demographics
NPI:1740400787
Name:CULLINANE, GLORIA ANNE (MA, MFT,)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:ANNE
Last Name:CULLINANE
Suffix:
Gender:F
Credentials:MA, MFT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27322 CALLE ARROYO
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-6760
Mailing Address - Country:US
Mailing Address - Phone:949-489-2425
Mailing Address - Fax:949-489-9064
Practice Address - Street 1:27322 CALLE ARROYO
Practice Address - Street 2:SUITE B
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-6760
Practice Address - Country:US
Practice Address - Phone:949-489-2425
Practice Address - Fax:949-489-9064
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT021306106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist