Provider Demographics
NPI:1215329743
Name:BRENDA A. TULLY, LCSW
Entity type:Organization
Organization Name:BRENDA A. TULLY, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TULLY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:347-907-3646
Mailing Address - Street 1:340 FAIRMOUNT AVE
Mailing Address - Street 2:UNIT 307
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-4848
Mailing Address - Country:US
Mailing Address - Phone:347-907-3646
Mailing Address - Fax:
Practice Address - Street 1:245 W 29TH ST
Practice Address - Street 2:SUITE 304
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5208
Practice Address - Country:US
Practice Address - Phone:347-907-3646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-20
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73074208-R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty