Provider Demographics
NPI:1497709935
Name:MARULLO, KAREN GOLDMAN (LPC)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:GOLDMAN
Last Name:MARULLO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:GOLDMAN
Other - Last Name:OLSHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1145 SOUTH 52ND STREET
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35222
Mailing Address - Country:US
Mailing Address - Phone:205-530-6855
Mailing Address - Fax:205-510-2790
Practice Address - Street 1:2909 CRESCENT AVENUE
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209
Practice Address - Country:US
Practice Address - Phone:205-530-6855
Practice Address - Fax:205-510-2790
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
6227769OtherUNITED BEHAVIORAL HEALTH
AL51516251OtherBLUE CROSS BLUE SHIELD
AL330000034Medicaid
AL51521563OtherBLUE CROSS BLUE SHIELD
AL6284664OtherALL KIDS INSURANCE