Individual
BRIDGET R FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
742 JAMES ST, SYRACUSE, NY 13203-2017
(315) 703-2786
(315) 703-2730
Mailing address
742 JAMES ST, SYRACUSE, NY 13203-2017
(315) 703-2700
(315) 703-2730
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
091922
NY
1041C0700X
Clinical Social Worker
Primary
090379
NY
Other
Enumeration date
02/19/2019
Last updated
08/06/2023
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