Provider Demographics
NPI:1013035427
Name:STRULL, JUDITH (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:
Last Name:STRULL
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 ELLISON RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-1434
Mailing Address - Country:US
Mailing Address - Phone:617-965-1247
Mailing Address - Fax:617-332-8472
Practice Address - Street 1:61 ELLISON RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-1434
Practice Address - Country:US
Practice Address - Phone:617-965-1247
Practice Address - Fax:617-332-8472
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1019301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical