Provider Demographics
NPI:1730390188
Name:FULMEN, JEZZIE (MFT INTERN)
Entity type:Individual
Prefix:
First Name:JEZZIE
Middle Name:
Last Name:FULMEN
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:FULMEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1390 MARKET ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-5402
Mailing Address - Country:US
Mailing Address - Phone:415-626-7000
Mailing Address - Fax:
Practice Address - Street 1:103 HAYES ST.
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102
Practice Address - Country:US
Practice Address - Phone:415-626-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 44550106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist