Active NPI
Chester Wayne Bullock Jr., PSYD, MED
- Psychologist
- Washington, DC
National Provider Identifier
1003043696
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- Practice address
- 910 17TH St NW Ste 419
Washington, DC 20006-2605 - Phone
- (202) 505-2795
- NPI assigned
- Jun 22, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | Primary |
Addresses
Primary practice location
910 17TH St NW Ste 419
Washington, DC 20006-2605
Mailing address
910 17TH St NW Ste 419
Washington, DC 20006-2605
Phone (202) 505-2795
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654819200000",
"number": "1003043696",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "910 17TH ST NW STE 419",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200062605",
"telephone_number": "202-505-2795"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "910 17TH ST NW STE 419",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200062605",
"telephone_number": "202-505-2795"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BULLOCK",
"first_name": "CHESTER",
"middle_name": "WAYNE",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "PSYD, MED",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-06-22",
"last_updated": "2022-06-10",
"certification_date": "2022-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.