Provider Demographics
NPI:1871516732
Name:FULGENZI, GEORGIA LYNN (LCSW)
Entity type:Individual
Prefix:MS
First Name:GEORGIA
Middle Name:LYNN
Last Name:FULGENZI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 INDIAN PINE LN
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7594
Mailing Address - Country:US
Mailing Address - Phone:724-935-7143
Mailing Address - Fax:
Practice Address - Street 1:1 WILLIAMSBURG PL
Practice Address - Street 2:#220
Practice Address - City:WARRENDALE
Practice Address - State:PA
Practice Address - Zip Code:15086-7540
Practice Address - Country:US
Practice Address - Phone:724-814-9521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0160311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102769256 0002Medicaid
PA627369OtherHIGHMARK PROVIDER NUMBER