Provider Demographics
NPI:1588676217
Name:FULLER, ALLISON (LCSW)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:FULLER
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:MACLAGGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 MOUNTAIN LAUREL
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-2217
Mailing Address - Country:US
Mailing Address - Phone:518-847-5143
Mailing Address - Fax:
Practice Address - Street 1:5 MOUNTAIN LAUREL
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-2217
Practice Address - Country:US
Practice Address - Phone:518-847-5143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069310104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00069310Medicaid
782073OtherMVP
782073OtherMVP