Provider Demographics
NPI:1215206073
Name:CIULLA, LISA (MSED, NCSP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CIULLA
Suffix:
Gender:F
Credentials:MSED, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 LEONARD BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-3933
Mailing Address - Country:US
Mailing Address - Phone:516-488-9555
Mailing Address - Fax:
Practice Address - Street 1:500 LEONARD BLVD
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-3933
Practice Address - Country:US
Practice Address - Phone:516-488-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01378665Medicaid