Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PY6630 | FL |
Y | 103TC0700X | Clinical Psychologist | PY6630 | FL |
NPI | 1013134840 |
---|---|
Provider Name | Dr. Jennifer Ruth Fulmer |
First Address | Hollywood, FL 33024-8067 |
Second Address | Hollywood, FL 33024-8067 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 08/07/2007 |