MEDICARE: ELIZABETH BULLINGER LICSW

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	1041C0700X	Clinical Social Worker	ISW01171	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30021-4	OTHER	RI	BLUE CROSS & BLUE SHIELD

General Provider Information

NPI Number	:	1558306951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH BULLINGER LICSW

Provider Business Mailing Address
First Line	:	650 TEN ROD RD
Second Line	:
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-4238
Country	:	US
Telephone Number	:	401-263-3003
Fax Number	:

Provider Business Practice Location Address
First Line	:	650 TEN ROD RD
Second Line	:
City	:	NORTH KINGSTOWN
State	:	RI
Zip	:	02852-4238
Country	:	US
Telephone Number	:	401-263-3003
Fax Number	:

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

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	02/02/2026

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