Provider Demographics
NPI:1245363878
Name:CHIULLI, STEPHEN J (PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:CHIULLI
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Gender:M
Credentials:PHD
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Mailing Address - Street 1:2201 SAN PEDRO DR NE
Mailing Address - Street 2:BUILDING 1, SUITE 215
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4133
Mailing Address - Country:US
Mailing Address - Phone:505-889-0426
Mailing Address - Fax:505-883-7304
Practice Address - Street 1:2201 SAN PEDRO DR NE
Practice Address - Street 2:BUILDING 1, SUITE 215
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4133
Practice Address - Country:US
Practice Address - Phone:505-889-0426
Practice Address - Fax:505-883-7304
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM500103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM00NB60OtherBLUE CROSS
NM7395OtherLOVELACE HEALTH PLAN
NM7395OtherCIGNA