Healthcare Provider Details

I. General information

NPI: 1245534387
Provider Name (Legal Business Name): T. A. LAWRENCE HULL PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2011
Last Update Date: 01/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 GREAT RD SUITE 203
ACTON MA
01720-5666
US

IV. Provider business mailing address

77 GREAT RD SUITE 203
ACTON MA
01720-5666
US

V. Phone/Fax

Practice location:
  • Phone: 978-263-5771
  • Fax: 978-263-5778
Mailing address:
  • Phone: 978-263-5771
  • Fax: 978-263-5778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1572
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: