Individual
GINA D'ULISSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CASAC
Contact information
Practice address
212 W MAIN ST, RIVERHEAD, NY 11901-2841
(631) 369-7800
Mailing address
PO BOX 464, SHIRLEY, NY 11967-0464
(631) 889-7772
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
24807
NY
Other
Enumeration date
02/03/2014
Last updated
02/03/2014
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