Provider Demographics
NPI:1427427400
Name:RULLI, ALEXANDRA M (LCSW)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:M
Last Name:RULLI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 OLD COACH RD
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3801
Mailing Address - Country:US
Mailing Address - Phone:516-589-4110
Mailing Address - Fax:
Practice Address - Street 1:52 BAYVIEW AVE
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-4308
Practice Address - Country:US
Practice Address - Phone:516-589-4110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-19
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094696-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker