Provider Demographics
NPI:1841189271
Name:OUT OF THE WOOD PSYCHIATRY
Entity type:Organization
Organization Name:OUT OF THE WOOD PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MASULLO
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:856-208-7398
Mailing Address - Street 1:900 HADDON AVE STE 300-6
Mailing Address - Street 2:
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-2101
Mailing Address - Country:US
Mailing Address - Phone:856-208-7398
Mailing Address - Fax:
Practice Address - Street 1:900 HADDON AVE STE 300-6
Practice Address - Street 2:
Practice Address - City:COLLINGSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08108-2101
Practice Address - Country:US
Practice Address - Phone:856-208-7398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty