Provider Demographics
NPI:1558987610
Name:ZULLICH, LIANNA KAY (LMSW)
Entity Type:Individual
Prefix:MS
First Name:LIANNA
Middle Name:KAY
Last Name:ZULLICH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 BARKER STREET
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-2013
Mailing Address - Country:US
Mailing Address - Phone:716-883-1914
Mailing Address - Fax:716-883-7637
Practice Address - Street 1:70 BARKER STREET
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-2013
Practice Address - Country:US
Practice Address - Phone:716-883-1914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1089471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical