Provider Demographics
NPI:1427347269
Name:PULIDO, JENNIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:JENNIE
Middle Name:
Last Name:PULIDO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 3RD AVE
Mailing Address - Street 2:APT. 1112
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-2129
Mailing Address - Country:US
Mailing Address - Phone:718-222-0933
Mailing Address - Fax:
Practice Address - Street 1:30 3RD AVE
Practice Address - Street 2:APT. 1112
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-2129
Practice Address - Country:US
Practice Address - Phone:917-208-6331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078170-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical