Basic Information
| Provider Information | |||||||||
| NPI: | 1104438258 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BULLOCK-JOHNSON | ||||||||
| FirstName: | RAMONA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MSW, LCSW-A, LCAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 99 TOPEKA ST | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174421499 | ||||||||
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| Practice Location | |||||||||
| Address1: | 99 TOPEKA ST | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174421499 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2020 | ||||||||
| LastUpdateDate: | 08/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.