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NPI Code Detail

MEDICARE: CHRISTINA BULLER LISW, LCSW

MEDICARE: CHRISTINA BULLER LISW, 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
11041C0700XClinical Social Worker254111KY
21041C0700XClinical Social WorkerI.1700577OH

General Provider Information

NPI Number : 1538429485
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINA BULLER LISW, LCSW
Provider Business Mailing Address
First Line : 4790 RED BANK RD STE 128
Second Line :
City : CINCINNATI
State : OH
Zip : 45227-1509
Country : US
Telephone Number : 513-731-3346
Fax Number :
Provider Business Practice Location Address
First Line : 4790 RED BANK RD STE 128
Second Line :
City : CINCINNATI
State : OH
Zip : 45227-1509
Country : US
Telephone Number : 513-731-3346
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2012
Last Update Date : 01/16/2020

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