Individual
DONNA FASULLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3027 MARINA BAY DR, SUITE 110, LEAGUE CITY, TX 77573-2729
(713) 687-7644
(281) 240-6481
Mailing address
3027 MARINA BAY DR, SUITE 110, LEAGUE CITY, TX 77573-2729
(713) 687-7644
(281) 240-6481
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1041C0700X
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00S03P
BC/BS
TX
05
—
124104401
—
TX
05
—
146355602
—
TX
Enumeration date
05/03/2006
Last updated
06/23/2009
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