Provider Demographics
NPI:1154938058
Name:PULLI, DAVID WILLIAM (LMSW)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WILLIAM
Last Name:PULLI
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 PALMER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GANSEVOORT
Mailing Address - State:NY
Mailing Address - Zip Code:12831-1942
Mailing Address - Country:US
Mailing Address - Phone:646-294-0955
Mailing Address - Fax:
Practice Address - Street 1:51 PALMER RIDGE RD
Practice Address - Street 2:
Practice Address - City:GANSEVOORT
Practice Address - State:NY
Practice Address - Zip Code:12831-1942
Practice Address - Country:US
Practice Address - Phone:646-294-0955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066717-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker