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NPI Code Detail

MEDICARE: DR. MARY MARGARET FULLER PHD

MEDICARE: DR. MARY MARGARET FULLER PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorLMH 3125FL
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1538130984
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY MARGARET FULLER PHD
Provider Business Mailing Address
First Line : 40347 US HIGHWAY 19 N STE 103
Second Line :
City : TARPON SPRINGS
State : FL
Zip : 34689-4841
Country : US
Telephone Number : 727-460-9834
Fax Number : 727-772-8212
Provider Business Practice Location Address
First Line : 40347 US HIGHWAY 19 N STE 103
Second Line :
City : TARPON SPRINGS
State : FL
Zip : 34689-4841
Country : US
Telephone Number : 727-330-8932
Fax Number : 727-772-8212
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2006
Last Update Date : 06/09/2015

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