MEDICARE: JOANNA ELIZABETH HULTON PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	00376-1	NY
2	102L00000X	Psychoanalyst	0005771	NY

General Provider Information

NPI Number	:	1710645916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA ELIZABETH HULTON PH.D.

Provider Business Mailing Address
First Line	:	8 VALLEY DR
Second Line	:
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-1455
Country	:	US
Telephone Number	:	631-421-7295
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 VALLEY DR
Second Line	:
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-1455
Country	:	US
Telephone Number	:	631-421-7295
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2021
Last Update Date	:	12/04/2021

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