Basic Information
| Provider Information | |||||||||
| NPI: | 1538105804 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FULTON | ||||||||
| FirstName: | NOREEN | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1803 MOUNT ROSE AVE | ||||||||
| Address2: | SUITE B3 | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174033026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178511405 | ||||||||
| FaxNumber: | 7178516349 | ||||||||
| Practice Location | |||||||||
| Address1: | 3550 CONCORD RD | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174028626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178516340 | ||||||||
| FaxNumber: | 7178516349 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 02/07/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | CW012735 | PA | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | CW012735 | PA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 2027483 | 01 | PA | CIGNA BEHAVIORAL HEALTH | OTHER | 132760 | 01 | PA | VALUE OPTIONS | OTHER | 734869 | 01 | PA | PABS (FEP ONLY) | OTHER | 230674000 | 01 | PA | MAGELLAN | OTHER | 01092904 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 68746501 | 01 | PA | BC/BS OF MD CARE FIRST | OTHER | 273324 | 01 | PA | MAMSI | OTHER |