Healthcare Provider Details

I. General information

NPI: 1770551038
Provider Name (Legal Business Name): PATRICIA BULLARD-BATES PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 IRVING ST NW
WASHINGTON DC
20010-2921
US

IV. Provider business mailing address

102 IRVING ST NW
WASHINGTON DC
20010-2921
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-1170
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1421
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: