Active NPI
Roger Zullo, LADC I
- Addiction (Substance Use Disorder) Counselor
- South Boston, MA
National Provider Identifier
1699481432
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 18961
- Practice address
- 210 Old Colony Ave
South Boston, MA 02127-2413 - Phone
- (617) 268-5000
- Fax
- (617) 268-5008
- NPI assigned
- Jan 25, 2023
- Last updated
- Jan 25, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 18961 | MA | Primary |
Addresses
Primary practice location
210 Old Colony Ave
South Boston, MA 02127-2413
Mailing address
210 Old Colony Ave
South Boston, MA 02127-2413
Phone (617) 268-5000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18961 | MA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1674604800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1674604800000",
"number": "1699481432",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 OLD COLONY AVE",
"city": "SOUTH BOSTON",
"state": "MA",
"postal_code": "021272413",
"telephone_number": "617-268-5000",
"fax_number": "617-268-5008"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 OLD COLONY AVE",
"city": "SOUTH BOSTON",
"state": "MA",
"postal_code": "021272413",
"telephone_number": "617-268-5000",
"fax_number": "617-268-5008"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZULLO",
"first_name": "ROGER",
"credential": "LADC I",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-01-25",
"last_updated": "2023-01-25",
"certification_date": "2022-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MA",
"license": "18961",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.