Provider Demographics
NPI:1518987130
Name:DI LULLO, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:DI LULLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 S. MAIN ST.
Mailing Address - Street 2:STE. 2411
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44311-1072
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:520 S MAIN ST
Practice Address - Street 2:STE 2411
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-1072
Practice Address - Country:US
Practice Address - Phone:330-762-7908
Practice Address - Fax:330-762-9959
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-2459101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health