Provider Demographics
NPI:1376736884
Name:MARULLO, LAURA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:MARULLO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7433 ANSLEY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7708
Mailing Address - Country:US
Mailing Address - Phone:561-255-4693
Mailing Address - Fax:561-733-1629
Practice Address - Street 1:7433 ANSLEY DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-7708
Practice Address - Country:US
Practice Address - Phone:561-255-4693
Practice Address - Fax:561-733-1629
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5314103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59789Medicare PIN