Healthcare Provider Details

I. General information

NPI: 1922541903
Provider Name (Legal Business Name): LISA TULLO PH.D., BCBA-D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2016
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1893 FRAYS RIDGE XING
EARLYSVILLE VA
22936-1878
US

IV. Provider business mailing address

1893 FRAYS RIDGE XING
EARLYSVILLE VA
22936-1878
US

V. Phone/Fax

Practice location:
  • Phone: 434-962-8119
  • Fax:
Mailing address:
  • Phone: 434-962-8119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-10-7656
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133000840
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: