Provider Demographics
NPI:1578851390
Name:CIULLA, LAURIE (M ED)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:CIULLA
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-2158
Mailing Address - Country:US
Mailing Address - Phone:973-402-9377
Mailing Address - Fax:
Practice Address - Street 1:312 MADISON ST
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-2158
Practice Address - Country:US
Practice Address - Phone:973-402-9377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst