Provider Demographics
NPI:1609374529
Name:LULLO, GENE R
Entity Type:Individual
Prefix:
First Name:GENE
Middle Name:R
Last Name:LULLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GENE
Other - Middle Name:R
Other - Last Name:ALLINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1830 S ALMA SCHOOL RD SUITE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210
Mailing Address - Country:US
Mailing Address - Phone:480-649-3352
Mailing Address - Fax:480-649-0022
Practice Address - Street 1:1830 S ALMA SCHOOL RD SUITE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210
Practice Address - Country:US
Practice Address - Phone:480-649-3352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-17181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical