Provider Demographics
NPI:1992531875
Name:PUGLISI, MADISON
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:PUGLISI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 RAILROAD AVE UNIT B4
Mailing Address - Street 2:
Mailing Address - City:EPPING
Mailing Address - State:NH
Mailing Address - Zip Code:03042-3540
Mailing Address - Country:US
Mailing Address - Phone:603-318-2635
Mailing Address - Fax:
Practice Address - Street 1:75 RAILROAD AVE UNIT B4
Practice Address - Street 2:
Practice Address - City:EPPING
Practice Address - State:NH
Practice Address - Zip Code:03042-3540
Practice Address - Country:US
Practice Address - Phone:603-318-2635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool