Provider Demographics
NPI:1184724841
Name:VULLO, KATHRYN TERESA (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:TERESA
Last Name:VULLO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3965 UNION ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CHILI
Mailing Address - State:NY
Mailing Address - Zip Code:14514-9718
Mailing Address - Country:US
Mailing Address - Phone:585-424-5980
Mailing Address - Fax:
Practice Address - Street 1:3965 UNION ST
Practice Address - Street 2:
Practice Address - City:NORTH CHILI
Practice Address - State:NY
Practice Address - Zip Code:14514-9718
Practice Address - Country:US
Practice Address - Phone:585-424-5980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015139103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS15139-9BOtherWORKERS COMP
NYS15139-9BOtherWORKERS COMP
NYDD1298Medicare ID - Type Unspecified