Individual
DR. DAVID PAYNE BULLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
MGH, 55 FRUIT STREET, BOSTON, MA 02114
(617) 219-1279
Mailing address
20 AUSTIN ST, MILTON, MA 02186-1104
(617) 698-1778
(781) 843-9199
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
6826
MA
103TC0700X
Clinical Psychologist
Primary
6826
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0526592
—
MA
01
—
W10653
BCBS
MA
Enumeration date
04/10/2006
Last updated
07/12/2024
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