MEDICARE: ALLISON FULLER LCSW

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
1	104100000X	Social Worker	069310	NY
2	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	782073	OTHER		MVP

General Provider Information

NPI Number	:	1588676217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON FULLER LCSW

Provider Business Mailing Address
First Line	:	5 MOUNTAIN LAUREL
Second Line	:
City	:	CLIFTON PARK
State	:	NY
Zip	:	12065-2217
Country	:	US
Telephone Number	:	518-847-5143
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 MOUNTAIN LAUREL
Second Line	:
City	:	CLIFTON PARK
State	:	NY
Zip	:	12065-2217
Country	:	US
Telephone Number	:	518-847-5143
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	02/26/2025

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