| Doctor Name: | MALCOLM MCCULLOUGH |
| NPI Number: | 1689897027 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 008754-1 |
| Business Practice Address: | 51 Lawrence Ave Malverne, NY - 115651406 |
| Business Phone Number: | 5164561363 |
| Business Fax Number: | |
| Mailing Address: | Po Box 826, EAST SETAUKET |
| State: | NY |
| Postal Code: | 117330636 |
| Phone Number: | 6314442938 |
| Fax Number: | |
| NPI Enumeration Date: | 04/11/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 008754-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |