Individual provider Active NPI

Debra Ann Bulger, LICSW

  • Clinical Social Worker
  • Lakeville, MA
National Provider Identifier
1649284464
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
1028865 Issued in MA
Practice address
104 Charles Eldridge Dr
Lakeville, MA 02347
Phone
(508) 947-1683
Fax
(508) 947-1684
NPI assigned
Jul 28, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 1028865 MA Primary

Addresses

Primary practice location

104 Charles Eldridge Dr
Lakeville, MA 02347

Mailing address

104 Charles Eldridge Dr
Lakeville, MA 02347
Phone (508) 947-1683

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050802000749 MA Practitioner - Clinical Social Worker 2466480223 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Tranquil Mind and Wellness, IncGroup PAC ID 9032191978, 2 clinicians

Practice addresses (Care Compare)

6 Alberta LN
Lakeville, MA 02347-1864
Phone (508) 947-1683

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1028865MAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Tranquil Mind & Wellness, Inc CurrentSince Dec 29, 1997 Accepting new patients

Locations

104 Charles Eldridge Rd
Lakeville, MA 02347
Phone (508) 813-3892

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1649284464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 CHARLES ELDRIDGE DR",
            "city": "LAKEVILLE",
            "state": "MA",
            "postal_code": "02347",
            "telephone_number": "508-947-1683",
            "fax_number": "508-947-1684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 CHARLES ELDRIDGE DR",
            "city": "LAKEVILLE",
            "state": "MA",
            "postal_code": "02347",
            "telephone_number": "508-947-1683",
            "fax_number": "508-947-1684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULGER",
        "first_name": "DEBRA",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "1028865",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeville, MA

Sources for this page

Verify at the official NPI Registry.