Provider Demographics
NPI:1962860841
Name:BULKA, LEIGH (MHC)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:
Last Name:BULKA
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 PARK PLACE
Mailing Address - Street 2:
Mailing Address - City:SCHOHARIE
Mailing Address - State:NY
Mailing Address - Zip Code:12157-5210
Mailing Address - Country:US
Mailing Address - Phone:518-295-2031
Mailing Address - Fax:518-295-8724
Practice Address - Street 1:113 PARK PL
Practice Address - Street 2:
Practice Address - City:SCHOHARIE
Practice Address - State:NY
Practice Address - Zip Code:12157-5211
Practice Address - Country:US
Practice Address - Phone:518-295-2031
Practice Address - Fax:518-295-8724
Is Sole Proprietor?:No
Enumeration Date:2016-02-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008522101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1386739944OtherAETNA
NY1386739944OtherBLUE SHIELD
NY1386739944OtherCDPHP
NY1386739944OtherFIDELIS
NY00555784Medicaid