Individual
JUSTIN BULLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(774) 442-3028
(774) 455-4229
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
11382
MA
Other
Enumeration date
11/04/2020
Last updated
12/22/2020
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