Provider Demographics
NPI:1982220398
Name:BULTRON, SONIA IVELISSE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SONIA
Middle Name:IVELISSE
Last Name:BULTRON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:273 QUEEN ST APT 14E
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-1922
Mailing Address - Country:US
Mailing Address - Phone:860-778-6649
Mailing Address - Fax:860-612-6384
Practice Address - Street 1:2150 CORBIN AVE
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-2266
Practice Address - Country:US
Practice Address - Phone:860-827-1958
Practice Address - Fax:860-612-6384
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0107201041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical