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General NPI Number Information
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NPI Number | 1558133249
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Entity Type | Individual
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Provider Name | ALLIE FULLER
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Gender | Female
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Dates
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Enumeration Date | 10/25/2023
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Last Update Date | 10/25/2023
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Provider Practice Location Address
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Address Line | 135 OCEAN PKWY APT 1P
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City | BROOKLYN
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State | NY
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Zip | 11218-2579
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Country | US
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Telephone | 347-378-7098
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Fax |
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Provider Business Mailing Address
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Address Line | 3611 31ST AVE APT 1H
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City | ASTORIA
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State | NY
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Zip | 11106-1081
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Country | US
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Telephone | 719-271-3569
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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