Provider Demographics
NPI:1861467896
Name:FULLER, BARBARA B (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:B
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 1:800 N FERNCREEK AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4127
Mailing Address - Country:US
Mailing Address - Phone:407-894-5666
Mailing Address - Fax:407-898-9321
Practice Address - Street 1:800 N FERNCREEK AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4127
Practice Address - Country:US
Practice Address - Phone:407-894-5666
Practice Address - Fax:407-898-9321
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00008571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ5250Medicare ID - Type UnspecifiedLCSW