Provider Demographics
NPI:1750764585
Name:CULLINGTON, KARLEEN (MA)
Entity type:Individual
Prefix:MISS
First Name:KARLEEN
Middle Name:
Last Name:CULLINGTON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 WALNUT AVE E
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-3844
Mailing Address - Country:US
Mailing Address - Phone:631-655-6954
Mailing Address - Fax:
Practice Address - Street 1:61 WALNUT AVE E
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-3844
Practice Address - Country:US
Practice Address - Phone:631-655-6954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYABR64800E01Medicaid