Provider Demographics
NPI:1861543274
Name:BULBULIAN, RACHEL SARA (LICSW)
Entity type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:SARA
Last Name:BULBULIAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 3RD AVE SE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-4619
Mailing Address - Country:US
Mailing Address - Phone:507-289-2332
Mailing Address - Fax:507-289-2332
Practice Address - Street 1:300 3RD AVE SE
Practice Address - Street 2:SUITE 208
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-4619
Practice Address - Country:US
Practice Address - Phone:507-289-2332
Practice Address - Fax:507-289-2332
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN195021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical