Healthcare Provider Details

I. General information

NPI: 1821063744
Provider Name (Legal Business Name): BARBARA BULRISS M.S., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 LONGWOOD AVE FLOOR 3
BOSTON MA
02115-5711
US

IV. Provider business mailing address

69 DEARBORN ST
SALEM MA
01970-2431
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6324
  • Fax: 617-730-0320
Mailing address:
  • Phone: 978-744-2017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number502
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: