Jennifer Fuller, LMHC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Practice address

1045 James St
Syracuse, NY 13203-2730

Phone

(315) 472-4471

Fax

(315) 472-1759

NPI assigned

Jul 10, 2008

Sex

Female

Sole proprietor

Yes

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: jennifer.fuller.p1@direct.liberty-resources.nextgenshare.com

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.

• Liberty Resources Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Syracuse, NY
  • NPI 1225254881
  Medicare reassignment NPD
• Liberty Resources, Inc.

  • Federally Qualified Health Center (FQHC)
  • Fulton, NY
  • NPI 1700688827
  NPD
• Liberty Resources, Inc.

  • Primary Care Clinic/Center
  • Syracuse, NY
  • NPI 1821485483
  NPD

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

{
    "created_epoch": "1215648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479340800000",
    "number": "1467615377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1045 JAMES ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132032730",
            "telephone_number": "315-472-4471",
            "fax_number": "315-472-1759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 JAMES ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132032730",
            "telephone_number": "315-472-4471",
            "fax_number": "315-472-1759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "JENNIFER",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-10",
        "last_updated": "2016-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donna M Fullagar Owens, PT
• Christopher J Fullagar, MD
• Bridget R Fuller, LCSW
• Dale W Fuller, LCSW
• Haley Fuller, CNM
• Kolleen Marian Fuller, RNNP
• Melissa Fuller
• Paul G Fuller Jr., MD
• Rebecca Lynn Fuller, RD, CDN
• Abigail Maureen Funari, MD

• Adult Mental Health Clinic/Center in Syracuse, NY
• Providers in Syracuse, NY by specialty
• Adult Mental Health Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2016; 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.