Provider Demographics
NPI:1801022736
Name:PULLIAM, BERTHA V (MS,CSW)
Entity Type:Individual
Prefix:MRS
First Name:BERTHA
Middle Name:V
Last Name:PULLIAM
Suffix:
Gender:F
Credentials:MS,CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 N 68TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-3932
Mailing Address - Country:US
Mailing Address - Phone:414-550-8117
Mailing Address - Fax:
Practice Address - Street 1:5250 N 68TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-3932
Practice Address - Country:US
Practice Address - Phone:414-550-8117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health