Provider Demographics
NPI:1366855736
Name:FULVIO, ALISA LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:LYNN
Last Name:FULVIO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 POST RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6039
Mailing Address - Country:US
Mailing Address - Phone:203-231-3359
Mailing Address - Fax:
Practice Address - Street 1:1330 POST RD
Practice Address - Street 2:SUITE 4
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6039
Practice Address - Country:US
Practice Address - Phone:203-231-3359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0081961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical