Provider Demographics
NPI:1164744025
Name:FULDAUER, ARTHUR (LISW)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:
Last Name:FULDAUER
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 IDALIA BLDG B
Mailing Address - Street 2:
Mailing Address - City:BERNALILLO
Mailing Address - State:NM
Mailing Address - Zip Code:87004-6303
Mailing Address - Country:US
Mailing Address - Phone:505-867-2291
Mailing Address - Fax:505-867-0107
Practice Address - Street 1:1500 IDALIA BLDG B
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-6303
Practice Address - Country:US
Practice Address - Phone:505-867-2291
Practice Address - Fax:505-867-0107
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-2249104100000X, 1041C0700X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator