Healthcare Provider Details

I. General information

NPI: 1316379464
Provider Name (Legal Business Name): SANTINO LOVULLO LBA, BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2013
Last Update Date: 02/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 CITRUS BLVD STE A1
NEW ORLEANS LA
70123-8505
US

IV. Provider business mailing address

5700 CITRUS BLVD STE A1
NEW ORLEANS LA
70123-8505
US

V. Phone/Fax

Practice location:
  • Phone: 866-727-8274
  • Fax:
Mailing address:
  • Phone: 866-727-8274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY 25783
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: