Provider Demographics
NPI:1922541903
Name:TULLO, LISA (PHD, BCBA-D)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:TULLO
Suffix:
Gender:F
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1893 FRAYS RIDGE XING
Mailing Address - Street 2:
Mailing Address - City:EARLYSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22936-1878
Mailing Address - Country:US
Mailing Address - Phone:434-962-8119
Mailing Address - Fax:
Practice Address - Street 1:1893 FRAYS RIDGE XING
Practice Address - Street 2:
Practice Address - City:EARLYSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22936-1878
Practice Address - Country:US
Practice Address - Phone:434-962-8119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-10-7656103K00000X
VA0133000840103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst