Provider Demographics
NPI:1639291180
Name:JAMES R. ZULLO, PH.D. P.C.
Entity type:Organization
Organization Name:JAMES R. ZULLO, PH.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:ZULLO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:773-342-1846
Mailing Address - Street 1:55 E WASHINGTON ST
Mailing Address - Street 2:SUITE 3800
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-2103
Mailing Address - Country:US
Mailing Address - Phone:773-342-1846
Mailing Address - Fax:312-917-1010
Practice Address - Street 1:55 E WASHINGTON ST
Practice Address - Street 2:SUITE 3800
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-2103
Practice Address - Country:US
Practice Address - Phone:773-342-1846
Practice Address - Fax:312-917-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208417Medicare ID - Type Unspecified