Provider Demographics
NPI:1144247081
Name:KULLEN, EMILY ANN (LCSW)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:KULLEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 JUMPING BROOK RD
Mailing Address - Street 2:BLDG 5, STE 201, ATTN: BEHAVIORAL HEALTH CREDENTIALING
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753
Mailing Address - Country:US
Mailing Address - Phone:732-643-4372
Mailing Address - Fax:
Practice Address - Street 1:1200 JUMPING BROOK RD
Practice Address - Street 2:BLDG 5, STE 201
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-2634
Practice Address - Country:US
Practice Address - Phone:732-643-4363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37C00102600101YA0400X
NJ44SC057207001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)