Healthcare Provider Details

I. General information

NPI: 1912217993
Provider Name (Legal Business Name): SUSAN MARGARET FULE MSW, LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2010
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 GEORGIA ST NE STE A4
ALBUQUERQUE NM
87110-1391
US

IV. Provider business mailing address

9900 ACADEMY HILLS DR NE
ALBUQUERQUE NM
87111-1313
US

V. Phone/Fax

Practice location:
  • Phone: 505-891-1583
  • Fax: 505-891-1768
Mailing address:
  • Phone: 505-821-6387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-06601
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI-06601
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: