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General NPI Number Information
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NPI Number | 1154964286
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Entity Type | Individual
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Provider Name | KIERA BULFORD CRC
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Gender | Female
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Dates
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Enumeration Date | 10/22/2019
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Last Update Date | 10/22/2019
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Provider Practice Location Address
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Address Line | 370 JAMES ST STE 306
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City | NEW HAVEN
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State | CT
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Zip | 06513-3091
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Country | US
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Telephone | 203-974-3017
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Fax |
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Provider Business Mailing Address
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Address Line | 121 WOOSTER ST FL 3
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City | NEW HAVEN
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State | CT
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Zip | 06511-5720
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Country | US
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Telephone |
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Fax |
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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 | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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License Number | 111268
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License Number State | IL
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