MEDICARE: DR. RUTH LULL PSYD

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	103TC0700X	Clinical Psychologist	MA6472	MA

General Provider Information

NPI Number	:	1780751347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUTH LULL PSYD

Provider Business Mailing Address
First Line	:	76 BEDFORD ST STE 26
Second Line	:
City	:	LEXINGTON
State	:	MA
Zip	:	02420-4641
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	76 BEDFORD ST STE 26
Second Line	:
City	:	LEXINGTON
State	:	MA
Zip	:	02420-4641
Country	:	US
Telephone Number	:	781-674-9830
Fax Number	:

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	07/08/2007

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