Healthcare Provider Details

I. General information

NPI: 1679230403
Provider Name (Legal Business Name): DAVID ANGELO CIULLA LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2021
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 LONG POND RD
ROCHESTER NY
14626-4164
US

IV. Provider business mailing address

1555 LONG POND RD
ROCHESTER NY
14626-4164
US

V. Phone/Fax

Practice location:
  • Phone: 585-723-7712
  • Fax: 585-723-7287
Mailing address:
  • Phone: 585-723-7712
  • Fax: 585-723-7287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number011810
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: