Individual
NICOLE WRIGHT BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
55 HOPE ST, PROVIDENCE, RI 02906-2001
(401) 331-1350
(401) 277-3366
Mailing address
134 THURBERS AVE, PROVIDENCE, RI 02905-4754
(401) 331-1350
(401) 277-3366
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
CSW01357
RI
1041C0700X
Clinical Social Worker
Primary
ISW02480
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CSW01357
STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS DEPARTMENT OF HEALTH
RI
01
—
ISW02480
STATE OF RI
RI
Enumeration date
05/22/2012
Last updated
02/18/2015
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