MEDICARE: BRITNEY SHEA FULP LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	P012719	NC
2	1041C0700X	Clinical Social Worker	C013206	NC

General Provider Information

NPI Number	:	1346712700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITNEY SHEA FULP LCSW

Provider Business Mailing Address
First Line	:	9 PATHWAY DR
Second Line	:
City	:	CLAYTON
State	:	NC
Zip	:	27527-3383
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7406 CHAPEL HILL RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-5077
Country	:	US
Telephone Number	:	336-772-5238
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2018
Last Update Date	:	08/18/2020

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