Healthcare Provider Details

I. General information

NPI: 1245441203
Provider Name (Legal Business Name): DANIEL S MARULLO PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 09/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 7TH AVE S SUITE 500
BIRMINGHAM AL
35233-1711
US

IV. Provider business mailing address

PO BOX 11407 DRAWER 1492
BIRMINGHAM AL
35246-1492
US

V. Phone/Fax

Practice location:
  • Phone: 205-939-9810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number797
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number797
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: