Individual
PATRICIA BULLARD-BATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
102 IRVING ST NW, WASHINGTON, DC 20010-2921
(202) 877-1170
Mailing address
102 IRVING ST NW, WASHINGTON, DC 20010-2921
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1421
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
123386323
TRICARE
—
01
—
247625
MAMSI
—
01
—
40710022
BCBS
DC
01
—
549622-04
BS OF MD
MD
01
—
737285-000
AETNA
—
01
—
H360-0007
BS OF NCA
DC
Enumeration date
03/10/2006
Last updated
06/25/2009
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