Healthcare Provider Details

I. General information

NPI: 1598984338
Provider Name (Legal Business Name): STEPHEN MORSE PULOS PSY. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 FRENCH RD
ROCHESTER NY
14618-5373
US

IV. Provider business mailing address

74 SUNSET TRL
FAIRPORT NY
14450-1924
US

V. Phone/Fax

Practice location:
  • Phone: 585-261-0841
  • Fax:
Mailing address:
  • Phone: 585-377-0481
  • Fax: 585-242-5006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number014563-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: