Individual
MR. CRAIG BENJAMIN FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
210 W 70TH ST, SUITE 201, NEW YORK, NY 10023-4304
(917) 300-8742
Mailing address
308 E 90TH ST, APT. 2A, NEW YORK, NY 10128-5146
(917) 300-8742
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
019953
NY
Other
Enumeration date
12/10/2009
Last updated
01/22/2013
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