Tadayah Pulliam, MSW, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

44SC06023700 Issued in NJ

Practice address

299 Glenwood Ave Ste 201
Bloomfield, NJ 07003-2445

Phone

(862) 704-4645

NPI assigned

Oct 13, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/HBFIAA

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Newark Community Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Newark, NJ
  • NPI 1740345693

  NJ

  Medicare reassignment NPD
• Senior Care Therapy LLC

  • Clinical Psychologist
  • Passaic, NJ
  • NPI 1285898098

  Clinical, NJ

  Medicare reassignment NPD
• Therapeutically Fit Counseling, LLC

  • Clinical Social Worker
  • Bloomfield, NJ
  • NPI 1811671951

  Clinical

  NPD Authorized official
• Newark Community Health Centers, Inc

  • Federally Qualified Health Center (FQHC)
  • Newark, NJ
  • NPI 1366993586
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1634083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694044800000",
    "number": "1760145007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "299 GLENWOOD AVE STE 201",
            "city": "BLOOMFIELD",
            "state": "NJ",
            "postal_code": "070032445",
            "telephone_number": "862-704-4645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "299 GLENWOOD AVE STE 201",
            "city": "BLOOMFIELD",
            "state": "NJ",
            "postal_code": "070032445",
            "telephone_number": "862-704-4645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PULLIAM",
        "first_name": "TADAYAH",
        "credential": "MSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-13",
        "last_updated": "2023-09-07",
        "certification_date": "2023-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC06023700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Professional Occupational & Physical Therapy, PLLC
• Professional Occupational & Physical Therapy, PLLC
• Progressive Medical Imaging of Bloomfield, LLC
• Prospect Rehabilatation Services, Inc.
• Protocol Imaging LLC
• Pure Life Chiropractic
• Quality Health Care, Inc.
• Quantum Psychotherapy Group
• Randy Steven Quesada, M.D.
• Benjamin Quidangen

• All providers in Bloomfield, NJ
• Clinical Social Worker in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.