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General NPI Number Information
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NPI Number | 1669327581
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Entity Type | Individual
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Provider Name | ZOMELY GRULLON LCAT-LP, MA
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Gender | Female
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Dates
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Enumeration Date | 03/04/2026
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Last Update Date | 03/12/2026
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Provider Practice Location Address
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Address Line | 6704 MYRTLE AVE STE 2080
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City | GLENDALE
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State | NY
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Zip | 11385-7033
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Country | US
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Telephone | 347-871-5931
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Fax |
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Provider Business Mailing Address
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Address Line | 62 BAINBRIDGE ST APT 2A
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City | BROOKLYN
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State | NY
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Zip | 11233-1742
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Country | US
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Telephone | 914-885-4148
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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 | P139094
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License Number State | NY
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