Active NPI
Dale Kulick, PH.D.
- Clinical Psychologist
- Rochester, NY
National Provider Identifier
1750831442
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 014635-1
- Practice address
- 1111 Elmwood Ave
Rochester, NY 14620-3005 - Phone
- (585) 241-1362
- Fax
- (585) 241-1246
- NPI assigned
- Oct 6, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 014635-1 | NY | Primary |
Addresses
Primary practice location
1111 Elmwood Ave
Rochester, NY 14620-3005
Mailing address
1111 Elmwood Ave
Rochester, NY 14620-3005
Phone (585) 241-1362
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02137593 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 014635-1 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1475712000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475712000000",
"number": "1750831442",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1111 ELMWOOD AVE",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "146203005",
"telephone_number": "585-241-1362",
"fax_number": "585-241-1246"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1111 ELMWOOD AVE",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "146203005",
"telephone_number": "585-241-1362",
"fax_number": "585-241-1246"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KULICK",
"first_name": "DALE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-10-06",
"last_updated": "2016-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "014635-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02137593",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rochester, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.