Provider Demographics
NPI:1033105499
Name:BULLINGER, BRENDA (ISW)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:BULLINGER
Suffix:
Gender:F
Credentials:ISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4394
Mailing Address - Country:US
Mailing Address - Phone:401-732-3332
Mailing Address - Fax:401-739-0196
Practice Address - Street 1:227 CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4394
Practice Address - Country:US
Practice Address - Phone:401-732-3332
Practice Address - Fax:401-739-0196
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW000421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIP00027296OtherMEDICARE RAILROAD
RI2156802OtherCIGNA
RI240423OtherMHN
RI1027650OtherBEACON
RI1027650OtherNHS
RI412783OtherVAL6
RI213408OtherBLUE CROSS PROVIDER NUMBE
RI408807OtherBLUE CHIP