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General NPI Number Information
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NPI Number | 1982220398
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Entity Type | Individual
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Provider Name | SONIA IVELISSE BULTRON LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/22/2020
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Last Update Date | 07/10/2020
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Provider Practice Location Address
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Address Line | 2150 CORBIN AVE
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City | NEW BRITAIN
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State | CT
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Zip | 06053-2266
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Country | US
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Telephone | 860-827-1958
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Fax | 860-612-6384
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Provider Business Mailing Address
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Address Line | 273 QUEEN ST APT 14E
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City | SOUTHINGTON
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State | CT
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Zip | 06489-1922
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Country | US
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Telephone | 860-778-6649
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Fax | 860-612-6384
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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 | 010720
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License Number State | CT
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