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Phetsamon Dilullo

Social Worker

Behavioral Health & Social Service Providers

PECOS Enrollment

Based on the most recent information from CMS, provider Phetsamon Dilullo is legally eligible to order and refer claims for Part B and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1982168688
Provider Type
Individual
Full Name
Dilullo, Phetsamon
Gender
Female

Sole Proprietor
No
Enumeration Date
1/27/2019
Last Updated
4/12/2019

Contact Information

Practice Location

32 Maple Ave, Windsor, CT 06095-2922

(860) 973-9171

Unlisted Fax

Mailing Location

32 Maple Ave, Windsor, CT 06095-2922

(860) 973-9171

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License 010163 Connecticut

Phetsamon Dilullo

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Lawless, Virginia

Hudson, Cynthia

Farley, Lisa

Toce, Erik Anthony

Eigner, Laurel

Mayweather-Banks, Nichole

Pathways To Perseverance Llc

2nd Chances Llc

Boyd, Cherese T

Gill, Angelica