Provider Demographics
NPI:1609543016
Name:BULLER, SALLY SCRUGGS
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:SCRUGGS
Last Name:BULLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-0026
Mailing Address - Country:US
Mailing Address - Phone:860-980-3233
Mailing Address - Fax:
Practice Address - Street 1:336 HALLS HILL RD
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415-1452
Practice Address - Country:US
Practice Address - Phone:860-980-3233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst