Provider Demographics
NPI:1598107625
Name:PUGLISI, DAVID JAMES (LMSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JAMES
Last Name:PUGLISI
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:PO BOX 5
Mailing Address - Street 2:29 ACADEMY STREET
Mailing Address - City:AFTON
Mailing Address - State:NY
Mailing Address - Zip Code:13730-0005
Mailing Address - Country:US
Mailing Address - Phone:607-639-8208
Mailing Address - Fax:607-639-8257
Practice Address - Street 1:29 ACADEMY STREET
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:NY
Practice Address - Zip Code:13730-0005
Practice Address - Country:US
Practice Address - Phone:607-639-8208
Practice Address - Fax:607-639-8257
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY089260-1251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1760666598Medicaid