Provider Demographics
NPI:1982196622
Name:RULLO, MELISSA MARIE (LCADC, LCSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:RULLO
Suffix:
Gender:F
Credentials:LCADC, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 LONDON DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-2616
Mailing Address - Country:US
Mailing Address - Phone:732-575-2975
Mailing Address - Fax:
Practice Address - Street 1:600 ROUTE 35
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5018
Practice Address - Country:US
Practice Address - Phone:732-706-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC057108001041C0700X
NJ37LC00255500101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical