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NPI Code Detail

MEDICARE: MS. NANCY LOUISE FULLER LICPSY

MEDICARE: MS. NANCY LOUISE FULLER LICPSY
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
1103TC0700XClinical Psychologist11081MA

General Provider Information

NPI Number : 1497806491
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. NANCY LOUISE FULLER LICPSY
Provider Business Mailing Address
First Line : 175 WAMPUM ST
Second Line :
City : PLAINVILLE
State : MA
Zip : 02762-1605
Country : US
Telephone Number : 508-695-8987
Fax Number :
Provider Business Practice Location Address
First Line : 275 NICHOLS RD
Second Line :
City : FITCHBURG
State : MA
Zip : 01420-1919
Country : US
Telephone Number : 978-401-3970
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2007
Last Update Date : 06/18/2019

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