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Provider Information for 1548799828


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LAKISHA FULMORE


Sex: Female

NPI: 1548799828
Last Updated: 2022-07-21
Certification Date:

Details

NameValue
NPI1548799828
Enumeration Date2017-06-08
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 4419 3RD AVE
BRONX, NY 10457-2562
United States

Phone: 718-364-7700 | Fax:
 
Primary Practice Address 4419 THIRD AVENUE
BRONX, NY 10457
United States

Phone: 718-364-7700 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101YM0800X - Counselor - Mental HealthNY008363