Provider Demographics
NPI:1265647184
Name:DITULLIO, LINDA ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:ANN
Last Name:DITULLIO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 LAKEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1507
Mailing Address - Country:US
Mailing Address - Phone:973-857-7407
Mailing Address - Fax:
Practice Address - Street 1:10 ERIE ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-4000
Practice Address - Country:US
Practice Address - Phone:973-744-0012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC000404001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical