Healthcare Provider Details

I. General information

NPI: 1184724841
Provider Name (Legal Business Name): KATHRYN TERESA VULLO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3965 UNION ST
NORTH CHILI NY
14514-9718
US

IV. Provider business mailing address

3965 UNION ST
NORTH CHILI NY
14514-9718
US

V. Phone/Fax

Practice location:
  • Phone: 585-424-5980
  • Fax:
Mailing address:
  • Phone: 585-424-5980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number015139
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: