Provider Demographics
NPI:1235207580
Name:TULIS, ELAINE H (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:H
Last Name:TULIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 GRAY ROCK LN
Mailing Address - Street 2:
Mailing Address - City:CHAPPAQUA
Mailing Address - State:NY
Mailing Address - Zip Code:10514-2511
Mailing Address - Country:US
Mailing Address - Phone:914-238-5359
Mailing Address - Fax:914-238-5359
Practice Address - Street 1:21 GRAY ROCK LN
Practice Address - Street 2:
Practice Address - City:CHAPPAQUA
Practice Address - State:NY
Practice Address - Zip Code:10514-2511
Practice Address - Country:US
Practice Address - Phone:914-238-5359
Practice Address - Fax:914-238-5359
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6469-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0022639OtherGHI
NY00584414Medicaid
NYV13561Medicare ID - Type UnspecifiedPROVIDER NUMBER