Provider Demographics
NPI:1861594129
Name:CULLEN, MICHAEL II (LCSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:CULLEN
Suffix:II
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 E. WOODFIELD ROAD
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-5113
Mailing Address - Country:US
Mailing Address - Phone:847-918-8282
Mailing Address - Fax:847-918-8215
Practice Address - Street 1:3 W HAWTHORN PKWY
Practice Address - Street 2:SUITE 260
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1446
Practice Address - Country:US
Practice Address - Phone:847-918-8282
Practice Address - Fax:847-918-8215
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL320078OtherVALUE OPTIONS GRP #
IL344427OtherMHN PROVIDER NUMBER
IL1633897OtherBCBS GROUP NUMBER
IL207844Medicare ID - Type UnspecifiedMEDICARE GRP PROVIDER #
IL344427OtherMHN PROVIDER NUMBER