Provider Demographics
NPI:1710564315
Name:BULLOCK, SAIDAH DEBORAH
Entity Type:Individual
Prefix:MS
First Name:SAIDAH
Middle Name:DEBORAH
Last Name:BULLOCK
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 1:401 SCHENECTADY AVE APT 10E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-5475
Mailing Address - Country:US
Mailing Address - Phone:347-313-7494
Mailing Address - Fax:
Practice Address - Street 1:178 WALWORTH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-3912
Practice Address - Country:US
Practice Address - Phone:860-880-2446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-28
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health