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General NPI Number Information
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NPI Number | 1003196122
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Entity Type | Individual
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Provider Name | JOSHUA STEPHEN BULLOCK PH.D.
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Gender | Male
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Dates
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Enumeration Date | 08/20/2011
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Last Update Date | 08/20/2011
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Provider Practice Location Address
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Address Line | 114 BOSTON POST RD 2ND FLOOR
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City | WEST HAVEN
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State | CT
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Zip | 06516-2043
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Country | US
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Telephone | 203-479-8000
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Fax | 203-479-8001
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Provider Business Mailing Address
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Address Line | 114 BOSTON POST RD 2ND FLOOR
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City | WEST HAVEN
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State | CT
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Zip | 06516-2043
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Country | US
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Telephone | 203-479-8000
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Fax | 203-479-8001
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS01241
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License Number State | RI
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