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Kimberly Antoinette Bullock, lcsw

Social Worker, Clinical in Jamaica, NY. Individual provider (NPI-1).

NPI number1265708564
StatusActive
Last updated in NPPESMar 30, 2012

Details

NPI
1265708564
Entity type
Individual (NPI-1)
Name
Ms. Kimberly Antoinette Bullock
Credential
lcsw
Sex
Female
Sole proprietor
Yes
Enumeration date
Mar 30, 2012
Last updated
Mar 30, 2012

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1041C0700X Social Worker, Clinical075392NYYes

Practice location

17657 132nd Ave
Jamaica, NY 11434-5839

Phone 718-712-1790 · Fax 516-292-7008

Mailing address

17657 132nd Ave
Jamaica, NY 11434-5839

Phone 718-712-1790 · Fax 516-292-7008

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