Provider Demographics
NPI:1528242245
Name:CHERYL MCARDLE CULHANE LCSW PC
Entity type:Organization
Organization Name:CHERYL MCARDLE CULHANE LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCARDLE CULHANE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW PC
Authorized Official - Phone:815-965-1817
Mailing Address - Street 1:1495 NORTHROCK CT
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-1233
Mailing Address - Country:US
Mailing Address - Phone:815-965-1817
Mailing Address - Fax:815-965-9574
Practice Address - Street 1:1495 NORTHROCK CT
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-1233
Practice Address - Country:US
Practice Address - Phone:815-965-1817
Practice Address - Fax:815-965-9574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL530520Medicare UPIN