Provider Demographics
NPI:1003196122
Name:BULLOCK, JOSHUA STEPHEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:STEPHEN
Last Name:BULLOCK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 BOSTON POST RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-2043
Mailing Address - Country:US
Mailing Address - Phone:203-479-8000
Mailing Address - Fax:203-479-8001
Practice Address - Street 1:114 BOSTON POST RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-2043
Practice Address - Country:US
Practice Address - Phone:203-479-8000
Practice Address - Fax:203-479-8001
Is Sole Proprietor?:No
Enumeration Date:2011-08-20
Last Update Date:2011-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01241103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical