Provider Demographics
NPI:1760145007
Name:PULLIAM, TADAYAH (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:TADAYAH
Middle Name:
Last Name:PULLIAM
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 GLENWOOD AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2445
Mailing Address - Country:US
Mailing Address - Phone:862-704-4645
Mailing Address - Fax:
Practice Address - Street 1:299 GLENWOOD AVE STE 201
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2445
Practice Address - Country:US
Practice Address - Phone:862-704-4645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-13
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC060237001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical