Provider Demographics
NPI:1477101384
Name:FULLER, DEBORAH MARLENE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:MARLENE
Last Name:FULLER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 CALHOUN PL STE 600
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20855-3701
Mailing Address - Country:US
Mailing Address - Phone:240-777-4444
Mailing Address - Fax:240-777-4447
Practice Address - Street 1:7300 CALHOUN PL STE 600
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20855-3701
Practice Address - Country:US
Practice Address - Phone:240-777-4444
Practice Address - Fax:240-777-4447
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25159104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker