Provider Demographics
NPI:1447902028
Name:CULLEN, NICOLE ELLEN ESDRA (LMHC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ELLEN ESDRA
Last Name:CULLEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ELLEN
Other - Last Name:ESDRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:1 CROPLEY CT
Mailing Address - Street 2:
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-6002
Mailing Address - Country:US
Mailing Address - Phone:339-927-3812
Mailing Address - Fax:
Practice Address - Street 1:1 CROPLEY CT
Practice Address - Street 2:
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907-6002
Practice Address - Country:US
Practice Address - Phone:781-309-7715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11258101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health