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General NPI Number Information
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NPI Number | 1710564315
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Entity Type | Individual
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Provider Name | MS. SAIDAH DEBORAH BULLOCK
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Gender | Female
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Dates
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Enumeration Date | 03/28/2021
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Last Update Date | 03/28/2021
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Provider Practice Location Address
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Address Line | 178 WALWORTH ST
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City | BROOKLYN
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State | NY
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Zip | 11205-3912
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Country | US
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Telephone | 860-880-2446
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Fax |
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Provider Business Mailing Address
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Address Line | 401 SCHENECTADY AVE APT 10E
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City | BROOKLYN
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State | NY
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Zip | 11213-5475
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Country | US
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Telephone | 347-313-7494
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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