Individual
MS. CARRIE VENUS FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
21 GRAND ST, NEWBURGH, NY 12550-5628
(845) 562-7244
Mailing address
21 GRAND ST, NEWBURGH, NY 12550-5628
(845) 562-7244
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
R050688-1
NY
Other
Enumeration date
10/02/2006
Last updated
07/09/2007
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