Doctor Name: | DR. CLARISSA BULLITT |
NPI Number: | 1013096403 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH.D. |
License Number: | 014890 |
Business Practice Address: | Sbumc Hsc Level 10 Rm. 020 Stony Brook, NY - 117948101 |
Business Phone Number: | 6314442990 |
Business Fax Number: | |
Mailing Address: | Sbumc Hsc Level 10, Rm. 020 STONY BROOK |
State: | NY |
Postal Code: | 117948101 |
Phone Number: | 6314442990 |
Fax Number: | |
NPI Enumeration Date: | 11/04/2006 |
NPI Last Update Date: | 09/29/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 014890 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |