Provider Demographics
NPI:1225482391
Name:PUGSLEY, SALLY X (LCSW-CERTIFIED)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:PUGSLEY
Suffix:X
Gender:F
Credentials:LCSW-CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8108 HAMILTON SPRING RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-2716
Mailing Address - Country:US
Mailing Address - Phone:301-469-4917
Mailing Address - Fax:301-469-5917
Practice Address - Street 1:8108 HAMILTON SPRING RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-2716
Practice Address - Country:US
Practice Address - Phone:301-469-4917
Practice Address - Fax:301-469-5917
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD037041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical