Provider Demographics
NPI:1477735934
Name:FULLER, JANE CATHERINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:CATHERINE
Last Name:FULLER
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 1:1040 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-6030
Mailing Address - Country:US
Mailing Address - Phone:219-942-0076
Mailing Address - Fax:
Practice Address - Street 1:8585 BROADWAY
Practice Address - Street 2:SUITE 520
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7064
Practice Address - Country:US
Practice Address - Phone:219-942-0076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health