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General NPI Number Information
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NPI Number | 1427892074
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Entity Type | Individual
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Provider Name | JOHANNA FULOP
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Gender | Female
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Dates
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Enumeration Date | 06/19/2024
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 24865 DETROIT RD
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City | WESTLAKE
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State | OH
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Zip | 44145-2512
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Country | US
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Telephone | 440-250-8800
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Fax |
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Provider Business Mailing Address
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Address Line | 8175 W RIDGE DR
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City | BROADVIEW HEIGHTS
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State | OH
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Zip | 44147-1030
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Country | US
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Telephone | 216-357-8951
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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