Provider Demographics
NPI:1417963596
Name:BULLARD, SARAH E (PHD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:BULLARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 GURLEYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:STORRS
Mailing Address - State:CT
Mailing Address - Zip Code:06268-1416
Mailing Address - Country:US
Mailing Address - Phone:860-230-8851
Mailing Address - Fax:860-812-2317
Practice Address - Street 1:322 MAIN ST STE 2E-10
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-3152
Practice Address - Country:US
Practice Address - Phone:860-230-8851
Practice Address - Fax:860-812-2317
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002504103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD4000076411Medicare PIN