MEDICARE: JENNIFER PULLARO LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	44SC05397200	NJ

General Provider Information

NPI Number	:	1194954511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER PULLARO LCSW

Provider Business Mailing Address
First Line	:	8 LEEDS POINT RD
Second Line	:
City	:	GALLOWAY
State	:	NJ
Zip	:	08205-4203
Country	:	US
Telephone Number	:	609-412-4440
Fax Number	:

Provider Business Practice Location Address
First Line	:	536 MAPLE AVE
Second Line	:
City	:	LINWOOD
State	:	NJ
Zip	:	08221-1213
Country	:	US
Telephone Number	:	609-703-7849
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2009
Last Update Date	:	08/02/2024

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