Provider Demographics
NPI:1790872513
Name:PULLEN, CONSTANCE W (LCSW C)
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:W
Last Name:PULLEN
Suffix:
Gender:F
Credentials:LCSW C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25800 AVONIA LN
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MD
Mailing Address - Zip Code:21662-1417
Mailing Address - Country:US
Mailing Address - Phone:410-822-6501
Mailing Address - Fax:410-334-6960
Practice Address - Street 1:25800 AVONIA LN
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MD
Practice Address - Zip Code:21662-1417
Practice Address - Country:US
Practice Address - Phone:410-822-6501
Practice Address - Fax:410-334-6960
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06299101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
6293528OtherUNITED BEHAVIOR HEALTH
DC0007OtherCAREFIRST FEDERAL PIN
MD259147000OtherMAGELLAN
MD352441000OtherMAGELLAN PIN
100067559001OtherAMERICAN PSYCH SYSTEM
MD52742702OtherCAREFIRST BCBS PIN
MDLM49EAOtherCAREFIRST BCBS
2101679OtherUNITEDHEALTHCARE MAMSI PI
MD609550002Medicaid
MD609550005Medicaid
517251OtherUHC MAMSI GROUP
723622OtherNCPPO PIN
DCR968OtherCAREFIRST FEDERAL GROUP
2101679OtherUNITEDHEALTHCARE MAMSI PI
723622OtherNCPPO PIN