MEDICARE: LINDA A BULLEN LCSW

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
1	104100000X	Social Worker	SW0001697	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z5582	OTHER	FL	BLUECROSSBLUESHIELD

General Provider Information

NPI Number	:	1225117724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA A BULLEN LCSW

Provider Business Mailing Address
First Line	:	8461 LAKE WORTH RD
Second Line	:	SUITE 125
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2474
Country	:	US
Telephone Number	:	561-533-3903
Fax Number	:	561-244-5149

Provider Business Practice Location Address
First Line	:	8461 LAKE WORTH RD
Second Line	:	SUITE 125
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2474
Country	:	US
Telephone Number	:	561-533-3903
Fax Number	:	561-244-5149

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	07/08/2007

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Directions to “ LINDA A BULLEN LCSW” Practice Location

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