Individual
MALCOLM MCCULLOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
51 LAWRENCE AVE, MALVERNE, NY 11565-1406
(516) 456-1363
Mailing address
PO BOX 826, EAST SETAUKET, NY 11733-0636
(631) 444-2938
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
008754-1
NY
Other
Enumeration date
04/11/2007
Last updated
07/08/2007
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