Active NPI
Theresa S. Fuller
- Professional Counselor
- East Brunswick, NJ
National Provider Identifier
1780304097
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 37AC00514400
- Practice address
- 15 W Prospect St
East Brunswick, NJ 08816-2161 - Phone
- (732) 254-0600
- NPI assigned
- Aug 29, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 37AC00514400 | NJ | Primary |
Addresses
Primary practice location
15 W Prospect St
East Brunswick, NJ 08816-2161
Mailing address
28 Rocky Hill Rd
Princeton, NJ 08540-9469
Phone (732) 995-7807
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37AC00514400 | NJ | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1661731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661731200000",
"number": "1780304097",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "28 ROCKY HILL RD",
"city": "PRINCETON",
"state": "NJ",
"postal_code": "085409469",
"telephone_number": "732-995-7807"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 W PROSPECT ST",
"city": "EAST BRUNSWICK",
"state": "NJ",
"postal_code": "088162161",
"telephone_number": "732-254-0600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLER",
"first_name": "THERESA",
"middle_name": "S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-08-29",
"last_updated": "2022-08-29",
"certification_date": "2022-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NJ",
"license": "37AC00514400",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Brunswick, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.