Provider Demographics
NPI:1376041566
Name:FULMER, GLENDA MICHELLE (LSW)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:MICHELLE
Last Name:FULMER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:OIL CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16301-2330
Mailing Address - Country:US
Mailing Address - Phone:814-677-4005
Mailing Address - Fax:814-677-6159
Practice Address - Street 1:716 E 2ND ST
Practice Address - Street 2:
Practice Address - City:OIL CITY
Practice Address - State:PA
Practice Address - Zip Code:16301-2330
Practice Address - Country:US
Practice Address - Phone:814-677-4005
Practice Address - Fax:814-677-6159
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW133950104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker