Provider Demographics
NPI:1609063007
Name:FULGHAM, SAUNDRA RENEE (LSW)
Entity Type:Individual
Prefix:MS
First Name:SAUNDRA
Middle Name:RENEE
Last Name:FULGHAM
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 STATE ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1914
Mailing Address - Country:US
Mailing Address - Phone:814-454-4530
Mailing Address - Fax:814-456-2375
Practice Address - Street 1:2314 SASSAFRAS ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2722
Practice Address - Country:US
Practice Address - Phone:814-452-4505
Practice Address - Fax:814-455-8383
Is Sole Proprietor?:No
Enumeration Date:2007-09-29
Last Update Date:2007-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW126088104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker