Provider Demographics
NPI:1013134840
Name:FULMER, JENNIFER RUTH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:RUTH
Last Name:FULMER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 STIRLING RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-8067
Mailing Address - Country:US
Mailing Address - Phone:954-436-8326
Mailing Address - Fax:954-433-0603
Practice Address - Street 1:10000 STIRLING RD
Practice Address - Street 2:SUITE 6
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-8067
Practice Address - Country:US
Practice Address - Phone:954-436-8326
Practice Address - Fax:954-433-0603
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6630103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical