Healthcare Provider Details

I. General information

NPI: 1831421940
Provider Name (Legal Business Name): DEON BULLARD MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2010
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3458 NEELY RD
MC GUIRE AFB NJ
08641-5312
US

IV. Provider business mailing address

3458 NEELY RD
MC GUIRE AFB NJ
08641-5312
US

V. Phone/Fax

Practice location:
  • Phone: 866-377-2778
  • Fax: 609-754-9249
Mailing address:
  • Phone: 866-377-2778
  • Fax: 609-754-9249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05391000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: