Provider Demographics
NPI:1457139909
Name:FULLA-KAY, FINA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:FINA
Middle Name:
Last Name:FULLA-KAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:FINA
Other - Middle Name:
Other - Last Name:FULLA-KAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:18 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01108-2541
Mailing Address - Country:US
Mailing Address - Phone:413-657-8613
Mailing Address - Fax:
Practice Address - Street 1:271 CAREW ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2377
Practice Address - Country:US
Practice Address - Phone:413-748-9024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA229014104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker