Individual
RA-JANEE FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 INTERNATIONAL DR, BUDD LAKE, NJ 07828-1383
(833) 282-2223
Mailing address
676 PARK AVE APT 18-2A, EAST ORANGE, NJ 07017-1540
(862) 387-2682
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
F92196386352952
NJ
Other
Enumeration date
07/13/2023
Last updated
07/13/2023
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