Provider Demographics
NPI:1598820276
Name:PULEO, JOSEPH SALVATORE JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:SALVATORE
Last Name:PULEO
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 OAKWYNNE RD
Mailing Address - Street 2:
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-1621
Mailing Address - Country:US
Mailing Address - Phone:610-356-4706
Mailing Address - Fax:610-356-4706
Practice Address - Street 1:200 LAWRENCE RD
Practice Address - Street 2:SUITE 900
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3225
Practice Address - Country:US
Practice Address - Phone:610-356-4706
Practice Address - Fax:610-356-4706
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-003476-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0033404000OtherINDEPENDENCE BLUE CROSS
PA07220777Medicaid
PA5781214OtherAETNA HEALTH CARE
PA438241Medicare ID - Type UnspecifiedLICENSED PSYCHOLOGIST
PA07220777Medicaid