Healthcare Provider Details

I. General information

NPI: 1184548521
Provider Name (Legal Business Name): SAMANTHA ZULLO BCBA, LBA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 CHERRY ST
MILFORD CT
06460-3414
US

IV. Provider business mailing address

13 CHERRY ST
MILFORD CT
06460-3414
US

V. Phone/Fax

Practice location:
  • Phone: 475-309-9567
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-69154
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1790
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: