Stephen G Pulaski, LCSW
Individual provider Active NPI Clinical Social Worker · New London, CT
NPI 1447465653 · NPPES record last updated Jan 28, 2020
Key facts
- NPI
- 1447465653
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 006401 (CT)
- Practice address
- 400 Bayonet St Ste 304
New London, CT 06320-2600 - Phone
- (860) 287-3621
- NPI assigned
- May 11, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
400 Bayonet St
Suite 304
New London, CT 06320-2600
Phone 860443750592
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200304000210 | CT | Practitioner - Clinical Social Worker | 6204263262 | Practice locations: New London, CT |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 006401 | CT | MD | Clinical Social Worker |
| 6401 | CT | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sacred Intelligence | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 006401 | CT | Yes |
Addresses
Primary practice location
400 Bayonet St Ste 304
New London, CT 06320-2600
Mailing address
81 Hunting Ridge Dr
Mystic, CT 06355-1159
Phone (860) 287-3621
NPI Registry JSON
{
"created_epoch": "1178841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1580169600000",
"number": "1447465653",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "81 HUNTING RIDGE DR",
"city": "MYSTIC",
"state": "CT",
"postal_code": "063551159",
"telephone_number": "860-287-3621"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 BAYONET ST STE 304",
"city": "NEW LONDON",
"state": "CT",
"postal_code": "063202600",
"telephone_number": "860-287-3621"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PULASKI",
"first_name": "STEPHEN",
"middle_name": "G",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-11",
"last_updated": "2020-01-28",
"certification_date": "2020-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CT",
"license": "006401",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New London, CT
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All providers in New London, CT · Clinical Social Worker in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 28, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.