Provider Demographics
NPI:1386907020
Name:MCCULLOCH, EMMA ROSSITER-CULLEN (PSYD)
Entity type:Individual
Prefix:DR
First Name:EMMA
Middle Name:ROSSITER-CULLEN
Last Name:MCCULLOCH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 A SHATTUCK AVE
Mailing Address - Street 2:STE. 201
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709
Mailing Address - Country:US
Mailing Address - Phone:707-509-3603
Mailing Address - Fax:
Practice Address - Street 1:1521 A SHATTUCK AVE
Practice Address - Street 2:STE. 201
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709
Practice Address - Country:US
Practice Address - Phone:707-509-3603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAPSY33072101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health