Provider Demographics
NPI:1801626247
Name:BULALE, UBAH
Entity type:Individual
Prefix:
First Name:UBAH
Middle Name:
Last Name:BULALE
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 1:511 AVENUE OF THE AMERICAS UNIT 103
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8436
Mailing Address - Country:US
Mailing Address - Phone:310-844-5544
Mailing Address - Fax:
Practice Address - Street 1:5389 PLAYA VISTA DR APT D140
Practice Address - Street 2:
Practice Address - City:PLAYA VISTA
Practice Address - State:CA
Practice Address - Zip Code:90094-2525
Practice Address - Country:US
Practice Address - Phone:310-844-5544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15623101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional