Provider Demographics
NPI:1932346046
Name:GULLO, ANTHONY M (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:M
Last Name:GULLO
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Gender:M
Credentials:PHD, LCSW
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Other - First Name:
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Mailing Address - Street 1:8500 EXECUTIVE PARK AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2228
Mailing Address - Country:US
Mailing Address - Phone:703-698-5220
Mailing Address - Fax:703-573-2351
Practice Address - Street 1:8500 EXECUTIVE PARK AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2225
Practice Address - Country:US
Practice Address - Phone:703-698-5220
Practice Address - Fax:703-573-2351
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA09040001521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical