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NPI Code Detail

MEDICARE: DESIREE CELINDA BULLOCK LCSW-R

MEDICARE: DESIREE CELINDA BULLOCK LCSW-R
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerR040749-1NY

General Provider Information

NPI Number : 1215171442
Entity Type Code : Individual
Provider Name (Legal Business Name) : DESIREE CELINDA BULLOCK LCSW-R
Provider Business Mailing Address
First Line : 2640 PITKIN AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11208-2629
Country : US
Telephone Number : 718-827-8700
Fax Number : 718-827-8848
Provider Business Practice Location Address
First Line : 2640 PITKIN AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11208-2629
Country : US
Telephone Number : 718-827-8700
Fax Number : 718-827-8848
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2009
Last Update Date : 05/01/2009

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Directions to “ DESIREE CELINDA BULLOCK LCSW-R” Practice Location

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