Healthcare Provider Details

I. General information

NPI: 1952929051
Provider Name (Legal Business Name): SHEA ALISON FULLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2020
Last Update Date: 11/27/2023
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 WHIPPOORWILL LN
NAPLES FL
34105-5028
US

IV. Provider business mailing address

1223 WHIPPOORWILL LN
NAPLES FL
34105-5028
US

V. Phone/Fax

Practice location:
  • Phone: 239-304-1600
  • Fax: 239-280-5999
Mailing address:
  • Phone: 239-304-1600
  • Fax: 239-280-5999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW16490
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: