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General NPI Number Information
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NPI Number | 1235021908
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Entity Type | Individual
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Provider Name | STEPHEN J BULLOCK CDCA.192853
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Gender | Male
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Dates
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Enumeration Date | 07/17/2025
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 7593 TYLERS PLACE BLVD
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City | WEST CHESTER
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State | OH
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Zip | 45069-6308
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Country | US
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Telephone | 513-714-3400
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Fax |
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Provider Business Mailing Address
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Address Line | 39 LORI LN
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City | DAYTON
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State | OH
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Zip | 45449-2610
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Country | US
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Telephone | 937-979-5243
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CDCA.192853
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License Number State | OH
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