Provider Demographics
NPI:1780838177
Name:BULL, DEBORAH YVONNE (RN LMSW)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:YVONNE
Last Name:BULL
Suffix:
Gender:F
Credentials:RN LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 DURSTON AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-1329
Mailing Address - Country:US
Mailing Address - Phone:315-472-3827
Mailing Address - Fax:
Practice Address - Street 1:501 E FAYETTE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-1953
Practice Address - Country:US
Practice Address - Phone:315-435-3230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051603-1171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator