Provider Demographics
NPI:1184338808
Name:VAN LULING, LISA M (PSYD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:VAN LULING
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 THORNTON ST
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:MA
Mailing Address - Zip Code:01756-1004
Mailing Address - Country:US
Mailing Address - Phone:401-744-5220
Mailing Address - Fax:
Practice Address - Street 1:25 THORNTON ST
Practice Address - Street 2:
Practice Address - City:MENDON
Practice Address - State:MA
Practice Address - Zip Code:01756-1004
Practice Address - Country:US
Practice Address - Phone:401-744-5220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11304103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist