Provider Demographics
NPI:1497892848
Name:TULLY, GERARD MATTHEW (LMFT)
Entity type:Individual
Prefix:MR
First Name:GERARD
Middle Name:MATTHEW
Last Name:TULLY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38-46 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-4906
Mailing Address - Country:US
Mailing Address - Phone:201-796-0195
Mailing Address - Fax:
Practice Address - Street 1:15 FURLER ST
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-1844
Practice Address - Country:US
Practice Address - Phone:973-890-9180
Practice Address - Fax:973-890-9078
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37F100105800106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist