Provider Demographics
NPI:1477143030
Name:FULGENTI, ALLISON EVA
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:EVA
Last Name:FULGENTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2229 S STATE ST APT 111
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-6287
Mailing Address - Country:US
Mailing Address - Phone:586-872-4852
Mailing Address - Fax:
Practice Address - Street 1:2229 S STATE ST APT 111
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-6287
Practice Address - Country:US
Practice Address - Phone:586-872-4852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker