Provider Demographics
NPI:1609555135
Name:FULTON, JENNIFER A (LCSW)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:A
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 1:1130 MEETINGHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-8128
Mailing Address - Country:US
Mailing Address - Phone:610-529-4810
Mailing Address - Fax:
Practice Address - Street 1:1224 BALTIMORE PIKE STE 201
Practice Address - Street 2:
Practice Address - City:CHADDS FORD
Practice Address - State:PA
Practice Address - Zip Code:19317-7380
Practice Address - Country:US
Practice Address - Phone:610-529-4810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0175931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical