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Individual

THERESA BULLOCK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
144 COTTONWOOD ST, JERSEY CITY, NJ 07305-4864
(201) 344-5408
Mailing address
144 COTTONWOOD ST, JERSEY CITY, NJ 07305-4864

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
071258
NY

Other

Enumeration date
08/13/2019
Last updated
08/13/2019
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