Provider Demographics
NPI:1053905810
Name:PULITANO, JAY MONTALBANO (LMSW)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:MONTALBANO
Last Name:PULITANO
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 W 157TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-7601
Mailing Address - Country:US
Mailing Address - Phone:718-302-8132
Mailing Address - Fax:
Practice Address - Street 1:511 W 157TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-7601
Practice Address - Country:US
Practice Address - Phone:718-302-8132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111935104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker