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General NPI Number Information
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NPI Number | 1598448839
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Entity Type | Individual
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Provider Name | CHRISTOPHER TULLO MA, ED.S, LAC
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Gender | Male
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Dates
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Enumeration Date | 08/14/2023
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 75 N MAPLE AVE STE 101B
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3261
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Country | US
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Telephone | 551-250-1017
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Fax |
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Provider Business Mailing Address
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Address Line | 9 OLD LANE EXT
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City | TOWACO
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State | NJ
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Zip | 07082-1277
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Country | US
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Telephone | 973-387-5128
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 37AC00708700
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License Number State | NJ
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