Margaret Bullerjahn
Individual provider Active NPI Clinical Psychologist · Hattiesburg, MS
NPI 1295460004 · NPPES record last updated Nov 5, 2024
Key facts
- NPI
- 1295460004
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 0810008710 (VA)
- Practice address
- 118 College Dr
Hattiesburg, MS 39406-0002 - Phone
- (419) 494-9347
- NPI assigned
- Jul 18, 2022
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241122003186 | VA | Practitioner - Clinical Psychologist | 9931634227 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Childrens Specialty Group PLLC | Single Specialty | Current |
Accepting new patients |
Locations
680 Oyster Point Rd
Newport News, VA 23606
Phone (757) 668-4673
850 Southampton Ave
Norfolk, VA 23510
Phone (757) 668-4673
601 Childrens Ln
Norfolk, VA 23507
Phone (757) 668-7272
1924 Landstown Centre Way
Virginia Beach, VA 23456
Phone (757) 668-4673
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist |
103TC0700X | 0810008710 | VA | Yes |
Addresses
Primary practice location
118 College Dr
Hattiesburg, MS 39406-0002
Mailing address
401 Gresham Dr FL 9
Norfolk, VA 23507
Other providers in Hattiesburg, MS
- Tanya W Bryant
- Mary Buckley
- Stephen E Buckley
- Scott Buckner
- Sidne Buelow
- Lewis A Bullock
- Kimberly Bunch-Crump
- Steven Burch
- Devontre Stephon Burdette
- Justin Bryce Burge
All providers in Hattiesburg, MS · Clinical Psychologist in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 5, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.