Provider Demographics
NPI:1225117724
Name:BULLEN, LINDA A (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:A
Last Name:BULLEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8461 LAKE WORTH RD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2474
Mailing Address - Country:US
Mailing Address - Phone:561-533-3903
Mailing Address - Fax:561-244-5149
Practice Address - Street 1:8461 LAKE WORTH RD
Practice Address - Street 2:SUITE 125
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2474
Practice Address - Country:US
Practice Address - Phone:561-533-3903
Practice Address - Fax:561-244-5149
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW0001697104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ5582OtherBLUECROSSBLUESHIELD