Provider Demographics
NPI:1487795894
Name:PUMILIA, JOESPH M (EDD)
Entity type:Individual
Prefix:DR
First Name:JOESPH
Middle Name:M
Last Name:PUMILIA
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 MAIN ST
Mailing Address - Street 2:SUITE 606A
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-3040
Mailing Address - Country:US
Mailing Address - Phone:802-254-9922
Mailing Address - Fax:
Practice Address - Street 1:139 MAIN ST
Practice Address - Street 2:SUITE 606A
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-3040
Practice Address - Country:US
Practice Address - Phone:802-254-9922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048-0000666103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT112916OtherTEAMSTER
VT28910OtherBLUE CROSS-BLUESHIELD
VT292576OtherMBC
VT1043369OtherCIGNA
VT1012444Medicaid
VT7583185OtherAETNA