Healthcare Provider Details

I. General information

NPI: 1023893591
Provider Name (Legal Business Name): STEVEN ANDRIULLI MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SHORE RD
WAYNE NJ
07470-6320
US

IV. Provider business mailing address

59 ROCKLAND AVE
WOODLAND PARK NJ
07424-3344
US

V. Phone/Fax

Practice location:
  • Phone: 973-248-6292
  • Fax: 207-987-4349
Mailing address:
  • Phone: 973-703-0622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number864953
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number864953
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number864953
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number864953
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number864953
License Number StateNJ
# 6
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number864953
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: