Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PS01241 | RI |
Y | 103TC0700X | Clinical Psychologist | PS01241 | RI |
NPI | 1003196122 |
---|---|
Provider Name | Dr. Joshua Stephen Bullock |
First Address | West Haven, CT 06516-2043 |
Second Address | West Haven, CT 06516-2043 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2011 |
Last Update Date | 20/08/2011 |