Provider Demographics
NPI:1588676217
Name:FULLER, ALLISON (LCSW)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:FULLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:MACLAGGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 WASHINGTON AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-7303
Mailing Address - Country:US
Mailing Address - Phone:518-218-0000
Mailing Address - Fax:518-862-2175
Practice Address - Street 1:300 WASHINGTON AVENUE EXT
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-7303
Practice Address - Country:US
Practice Address - Phone:518-218-0000
Practice Address - Fax:518-862-2175
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069310104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
782073OtherMVP
NY00069310Medicaid
782073OtherMVP