Carrie Venus Fuller, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

R050688-1 Issued in NY

Practice address

21 Grand St
Newburgh, NY 12550-5628

Phone

(845) 562-7244

NPI assigned

Oct 2, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: carriefuller@tdh.allscriptsdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Carmel Psychological Health, PC

  • Psychologist
  • Carmel, NY
  • NPI 1720194335

  Clinical

  Medicare reassignment NPD
• Michele Winchester-Vega LCSW PLLC

  • Clinical Social Worker
  • New Windsor, NY
  • NPI 1831429414
  Medicare reassignment NPD
• Teladoc Health Medical Group, P.a.

  • Family Medicine Physician
  • Lewisville, TX
  • NPI 1245403567

  Clinical

  NPD
• Access: Supports for Living Inc

  • Multi-Specialty Clinic/Center
  • Middletown, NY
  • NPI 1528174976
  NPD (past)
• Access: Supports for Living Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Middletown, NY
  • NPI 1790326320
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1376636563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 GRAND ST",
            "city": "NEWBURGH",
            "state": "NY",
            "postal_code": "125505628",
            "telephone_number": "845-562-7244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 GRAND ST",
            "city": "NEWBURGH",
            "state": "NY",
            "postal_code": "125505628",
            "telephone_number": "845-562-7244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "CARRIE",
        "middle_name": "VENUS",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-02",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R050688-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ingrid Selma Frengle-Burke, N.P.
• George Aaron Freud, DDS
• Nejil Adonays Frias, LMSW
• Joshua Fuentes
• Emma Rose Fulciniti, CASAC-T
• Juan Gabriel, M.D.
• Gabriels Family Chiropractic, P.C.
• Christopher Michael Gabriels, D.C.
• Dana Lee Gage, MD
• Ketevan Gagnidze-McCormick, LMHC

• Clinical Social Worker in Newburgh, NY
• Providers in Newburgh, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.