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General NPI Number Information
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NPI Number | 1639538556
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Entity Type | Individual
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Provider Name | JEANETTE BULLER LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/20/2016
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Last Update Date | 02/14/2023
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Provider Practice Location Address
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Address Line | 4470 WEST SUNSET BLVD STE 107
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City | LOS ANGELES
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State | CA
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Zip | 90027
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Country | US
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Telephone | 323-205-7088
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 326
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City | LA PUENTE
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State | CA
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Zip | 91747-0326
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Country | US
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Telephone | 626-435-8851
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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 | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 83470
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License Number State | CA
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