Healthcare Provider Details

I. General information

NPI: 1861965527
Provider Name (Legal Business Name): F. REGIS BULMAN, LCSW, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2019
Last Update Date: 01/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 N HADDON AVE
HADDONFIELD NJ
08033-2306
US

IV. Provider business mailing address

27 WESTMINSTER DR
VOORHEES NJ
08043-3704
US

V. Phone/Fax

Practice location:
  • Phone: 856-438-0485
  • Fax:
Mailing address:
  • Phone: 856-438-0485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FRANCIS REGIS BULMAN
Title or Position: MANAGER
Credential: MSW, LCSW
Phone: 856-438-0485