Provider Demographics
NPI:1073258893
Name:FULLER, CATHERINE MARY (BCBA)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MARY
Last Name:FULLER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:560 SYLVAN AVE STE 2048
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-3165
Mailing Address - Country:US
Mailing Address - Phone:646-873-6600
Mailing Address - Fax:646-859-4440
Practice Address - Street 1:90 CANAL ST STE 400
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2022
Practice Address - Country:US
Practice Address - Phone:857-285-4520
Practice Address - Fax:646-859-4440
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1-22-58856103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst