Provider Demographics
NPI:1538105804
Name:FULTON, NOREEN E (LCSW)
Entity Type:Individual
Prefix:
First Name:NOREEN
Middle Name:E
Last Name:FULTON
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 1:1803 MOUNT ROSE AVE
Mailing Address - Street 2:SUITE B3
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3026
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-6349
Practice Address - Street 1:3550 CONCORD RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-8626
Practice Address - Country:US
Practice Address - Phone:717-851-6340
Practice Address - Fax:717-851-6349
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW012735104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2027483OtherCIGNA BEHAVIORAL HEALTH
PA132760OtherVALUE OPTIONS
PA734869OtherPABS (FEP ONLY)
PA230674000OtherMAGELLAN
PA01092904OtherCAPITAL BLUE CROSS
PA68746501OtherBC/BS OF MD CARE FIRST
PA273324OtherMAMSI
PA132760OtherVALUE OPTIONS
PA01092904OtherCAPITAL BLUE CROSS