Provider Demographics
NPI:1366115057
Name:PULLIAM, RAYMOND (RBT)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:PULLIAM
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5288
Mailing Address - Country:US
Mailing Address - Phone:732-367-3667
Mailing Address - Fax:
Practice Address - Street 1:1723 LYMAN PL NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-3027
Practice Address - Country:US
Practice Address - Phone:202-271-1276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician