Provider Demographics
NPI:1245613017
Name:LULOV, JONATHAN A (LMSW)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:A
Last Name:LULOV
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 W 45TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-3697
Mailing Address - Country:US
Mailing Address - Phone:917-992-6576
Mailing Address - Fax:
Practice Address - Street 1:530 W 45TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-3697
Practice Address - Country:US
Practice Address - Phone:917-992-6576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8682700171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor