Provider Demographics
NPI:1164703757
Name:FULTON, GALE BARBETTE (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:GALE
Middle Name:BARBETTE
Last Name:FULTON
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MS
Other - First Name:GALE
Other - Middle Name:BARBETTE
Other - Last Name:FULTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1202 COCHRAN AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-3301
Mailing Address - Country:US
Mailing Address - Phone:410-532-5779
Mailing Address - Fax:410-532-5779
Practice Address - Street 1:1202 COCHRAN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-3301
Practice Address - Country:US
Practice Address - Phone:410-532-5779
Practice Address - Fax:410-532-5779
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD128811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical