Provider Demographics
NPI:1477878908
Name:BULANDA, JEFFREY J (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:J
Last Name:BULANDA
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 N PINE GROVE AVE
Mailing Address - Street 2:#410
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-4196
Mailing Address - Country:US
Mailing Address - Phone:773-550-1620
Mailing Address - Fax:
Practice Address - Street 1:3825 N PINE GROVE AVE
Practice Address - Street 2:#410
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-4196
Practice Address - Country:US
Practice Address - Phone:773-550-1620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0120761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical