Provider Demographics
NPI:1972635258
Name:MCCULLOUGH, MEGAN (BSED,MSW,LSW)
Entity type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:BSED,MSW,LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 CHESTNUT ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4316
Mailing Address - Country:US
Mailing Address - Phone:215-625-9770
Mailing Address - Fax:215-625-9866
Practice Address - Street 1:1015 CHESTNUT ST
Practice Address - Street 2:SUITE 403
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4316
Practice Address - Country:US
Practice Address - Phone:215-625-9770
Practice Address - Fax:215-625-9866
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1237231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical