Provider Demographics
NPI:1841334109
Name:CULLEN PSYCHOLOGICAL SERVICES, PC
Entity type:Organization
Organization Name:CULLEN PSYCHOLOGICAL SERVICES, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:CULLEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:856-228-5390
Mailing Address - Street 1:80 BRYANT RD
Mailing Address - Street 2:
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-1446
Mailing Address - Country:US
Mailing Address - Phone:856-228-5390
Mailing Address - Fax:856-228-5390
Practice Address - Street 1:9331 OLD BUSTLETON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-4634
Practice Address - Country:US
Practice Address - Phone:856-228-5390
Practice Address - Fax:856-228-5390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002808L103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA466239000OtherMAGELLAN BEHAVIORAL HEALT
PAP824454OtherOTHER
PA172351OtherBLUE SHIELD
PA0049406000OtherBLUE CROSS
PA264826200OtherACS OWCP FECA
PA7579734Medicaid
PA264826200OtherACS OWCP FECA
PAP824454OtherOTHER