Provider Demographics
NPI:1225260243
Name:BULGER, ANNE ROSE (RN, LMFT)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:ROSE
Last Name:BULGER
Suffix:
Gender:F
Credentials:RN, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 PINE ST
Mailing Address - Street 2:UNIT # 4
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3529
Mailing Address - Country:US
Mailing Address - Phone:207-233-3658
Mailing Address - Fax:207-774-1626
Practice Address - Street 1:161 PINE ST
Practice Address - Street 2:UNIT # 4
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3529
Practice Address - Country:US
Practice Address - Phone:207-233-3658
Practice Address - Fax:207-774-1626
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMF3740106H00000X
MER058522163W00000X
WALF00002649106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No163W00000XNursing Service ProvidersRegistered Nurse