Kimberly Antoinette Bullock, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

075392 Issued in NY

Practice address

17657 132ND Ave
Jamaica, NY 11434-5839

Phone

(718) 712-1790

Fax

(516) 292-7008

NPI assigned

Mar 30, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1333065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1333065600000",
    "number": "1265708564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17657 132ND AVE",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114345839",
            "telephone_number": "718-712-1790",
            "fax_number": "516-292-7008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17657 132ND AVE",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114345839",
            "telephone_number": "718-712-1790",
            "fax_number": "516-292-7008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLOCK",
        "first_name": "KIMBERLY",
        "middle_name": "ANTOINETTE",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-03-30",
        "last_updated": "2012-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "075392",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charmaine Emeline Buckle-Wright, LPN
• Vishnu Budhram, RPH
• Kaitlyn Bueti
• Evita Bullen
• Maureen Christine Bullen, RN
• Linda Bulone, RN
• Precious Bunkley
• Olga Y Burbano
• Barbara Sabrina Burgess, LMSW
• Cristina Buricea, DPM

• Clinical Social Worker in Jamaica, NY
• Providers in Jamaica, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.