Provider Demographics
NPI:1538391602
Name:KULLER, ANDREW MARSHALL (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:MARSHALL
Last Name:KULLER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:115 MILL ST
Mailing Address - Street 2:RECREATION BUILDING - ROOM 129
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-1064
Mailing Address - Country:US
Mailing Address - Phone:617-855-3899
Mailing Address - Fax:617-855-3776
Practice Address - Street 1:115 MILL ST
Practice Address - Street 2:RECREATION BUILDING - ROOM 129
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-1064
Practice Address - Country:US
Practice Address - Phone:617-855-3899
Practice Address - Fax:617-855-3776
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9051103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical