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General NPI Number Information
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NPI Number | 1699171728
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Entity Type | Individual
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Provider Name | VERNIECE GREEN-FULFORD
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Gender | Female
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Dates
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Enumeration Date | 11/18/2014
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Last Update Date | 07/25/2022
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Provider Practice Location Address
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Address Line | 360 NEW DORP LN STE C
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City | STATEN ISLAND
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State | NY
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Zip | 10306-3035
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Country | US
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Telephone | 929-333-6905
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Fax | 929-566-8627
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Provider Business Mailing Address
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Address Line | 2744 HYLAN BLVD # 116
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City | STATEN ISLAND
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State | NY
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Zip | 10306-4658
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Country | US
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Telephone | 929-333-6905
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Fax | 929-566-8627
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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 | 010838
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License Number State | NY
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