Provider Demographics
NPI:1245355239
Name:BARBARA B FULLER, LCSW,P.A.
Entity type:Organization
Organization Name:BARBARA B FULLER, LCSW,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:B
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:407-894-5666
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0748AD363501101YA0400X
FLSW00008571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty