Healthcare Provider Details

I. General information

NPI: 1851457790
Provider Name (Legal Business Name): ELIZABETH ANN TULLOCH-DENT PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FISHER LANDAU CENTER 1165 MORRIS PARK AVE.
BRONX NY
10461
US

IV. Provider business mailing address

32 QUEENSLAND DR SW
HUNTSVILLE AL
35824-4114
US

V. Phone/Fax

Practice location:
  • Phone: 718-430-3900
  • Fax:
Mailing address:
  • Phone: 516-298-6112
  • Fax: 718-430-3989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number014578
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number2278
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: