Provider Demographics
NPI:1023226370
Name:FULLAND, DAVID ANTHONY (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ANTHONY
Last Name:FULLAND
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WEST 135TH STREET
Mailing Address - Street 2:SUITE 6U
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10030
Mailing Address - Country:US
Mailing Address - Phone:917-468-9840
Mailing Address - Fax:212-690-3241
Practice Address - Street 1:300 WEST 135TH STREET
Practice Address - Street 2:SUITE 6U
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10030
Practice Address - Country:US
Practice Address - Phone:917-468-9840
Practice Address - Fax:212-690-3241
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000013101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health