Provider Demographics
NPI:1194096974
Name:BULLEN, CAROLINE (PSYD)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:
Last Name:BULLEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N MILITARY TRL STE 205
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6306
Mailing Address - Country:US
Mailing Address - Phone:561-352-0684
Mailing Address - Fax:561-967-1569
Practice Address - Street 1:2500 N MILITARY TRL STE 205
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6306
Practice Address - Country:US
Practice Address - Phone:561-352-0684
Practice Address - Fax:561-967-1569
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6647103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical