Provider Demographics
NPI:1528655529
Name:PUGLISI, BRANDON (LCSW)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:PUGLISI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 WINFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-3415
Mailing Address - Country:US
Mailing Address - Phone:570-766-0772
Mailing Address - Fax:
Practice Address - Street 1:201 LACKAWANNA AVE STE 316
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1953
Practice Address - Country:US
Practice Address - Phone:570-766-0772
Practice Address - Fax:570-866-3518
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0215731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical