Provider Demographics
NPI:1821754078
Name:PULTORAK, JODI NOEL (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:NOEL
Last Name:PULTORAK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08691-1526
Mailing Address - Country:US
Mailing Address - Phone:609-651-3036
Mailing Address - Fax:
Practice Address - Street 1:503 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:ROBBINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08691-1526
Practice Address - Country:US
Practice Address - Phone:609-651-3036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2025-06-20
Deactivation Date:2022-12-12
Deactivation Code:
Reactivation Date:2025-06-20
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05380800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker