Provider Demographics
NPI:1124167689
Name:PULLMAN, JOSEPH (LCSW-R)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:PULLMAN
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6635 MORGAN HILL RD
Mailing Address - Street 2:
Mailing Address - City:TRUXTON
Mailing Address - State:NY
Mailing Address - Zip Code:13158-4117
Mailing Address - Country:US
Mailing Address - Phone:607-756-4650
Mailing Address - Fax:
Practice Address - Street 1:73 PORT WATSON ST
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-3027
Practice Address - Country:US
Practice Address - Phone:607-756-4650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR045996-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC3026Medicare ID - Type Unspecified