MEDICARE: MS. RACHEL SARA BULBULIAN 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	19502	MN

General Provider Information

NPI Number	:	1861543274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RACHEL SARA BULBULIAN LICSW

Provider Business Mailing Address
First Line	:	300 3RD AVE SE
Second Line	:	SUITE 208
City	:	ROCHESTER
State	:	MN
Zip	:	55904-4619
Country	:	US
Telephone Number	:	507-289-2332
Fax Number	:	507-289-2332

Provider Business Practice Location Address
First Line	:	300 3RD AVE SE
Second Line	:	SUITE 208
City	:	ROCHESTER
State	:	MN
Zip	:	55904-4619
Country	:	US
Telephone Number	:	507-289-2332
Fax Number	:	507-289-2332

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

Provider Enumeration Date	:	01/13/2007
Last Update Date	:	12/09/2009

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