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Individual

MR. JERRY LEE FULLER JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LCSW

Contact information

Practice address
31 NORTH AVE, BLOOMFIELD, NJ 07003-5516
(973) 338-8530
Mailing address
31 NORTH AVE, BLOOMFIELD, NJ 07003-5516
(973) 338-8530

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
44SC05222700
NJ

Other

Enumeration date
01/02/2007
Last updated
02/02/2009
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