Provider Demographics
NPI:1962389635
Name:FULLER, JENNIFER (CMHC, NBC-HWC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:FULLER
Suffix:
Gender:X
Credentials:CMHC, NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 SARATOGA AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05408-1121
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:86 LAKE ST STE 302
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5297
Practice Address - Country:US
Practice Address - Phone:802-999-7941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-16
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health