Provider Demographics
NPI:1447453907
Name:BULUCEA, TINA W (MSSA, LISW)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:W
Last Name:BULUCEA
Suffix:
Gender:F
Credentials:MSSA, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34900 CHARDON RD
Mailing Address - Street 2:STE 200
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44094-9161
Mailing Address - Country:US
Mailing Address - Phone:440-951-5600
Mailing Address - Fax:440-951-1293
Practice Address - Street 1:24200 CHAGRIN BLVD
Practice Address - Street 2:THE OFFICE PLACE
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5550
Practice Address - Country:US
Practice Address - Phone:216-831-6466
Practice Address - Fax:216-766-6084
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00081251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5575800Medicaid
BUSW19874Medicare ID - Type Unspecified
OH5575800Medicaid