Fasullo, Donna

Fasullo, Donna is an sole proprietor health care provider with primary practice located at 3027 Marina Bay Dr Suite 110, League City TX 77573-2729. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Fasullo, Donna can be contacted via phone (713) 687-7644.

Contact Information

Primary practice address
3027 Marina Bay Dr Suite 110 League City TX 77573-2729
Phone: (713) 687-7644
Fax: (281) 240-6481
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 1041C0700X Texas

Profile Details

NPI number 1326006735
LBN Legal business name Fasullo, Donna
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 3rd, 2006
Last updated Jun 23rd, 2009 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1326006735 NPPES
Texas MEDICAID 146355602
Texas Other 00S03P
Texas MEDICAID 124104401

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