Provider Demographics
NPI:1952929051
Name:FULLER, SHEA ALISON (LCSW)
Entity Type:Individual
Prefix:
First Name:SHEA
Middle Name:ALISON
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 1:1223 WHIPPOORWILL LN
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-5028
Mailing Address - Country:US
Mailing Address - Phone:239-304-1600
Mailing Address - Fax:239-280-5999
Practice Address - Street 1:1223 WHIPPOORWILL LN
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34105-5028
Practice Address - Country:US
Practice Address - Phone:239-304-1600
Practice Address - Fax:239-280-5999
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW164901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical