Provider Demographics
NPI:1568527513
Name:BULLOCK, ROXIA B (PHD LCSW ACSW)
Entity Type:Individual
Prefix:
First Name:ROXIA
Middle Name:B
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:PHD LCSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 SOMERSTOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562
Mailing Address - Country:US
Mailing Address - Phone:914-944-4043
Mailing Address - Fax:914-944-4043
Practice Address - Street 1:156 SOMERSTOWN ROAD
Practice Address - Street 2:
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562
Practice Address - Country:US
Practice Address - Phone:914-944-4043
Practice Address - Fax:914-944-4043
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYR0363751103T00000X, 1041C0700X
CT003004103T00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical