Provider Demographics
NPI:1053036905
Name:FULLER, OLGA GULYAYEVA (PHD)
Entity type:Individual
Prefix:DR
First Name:OLGA
Middle Name:GULYAYEVA
Last Name:FULLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 35TH ST STE C-556
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232-2019
Mailing Address - Country:US
Mailing Address - Phone:718-622-4058
Mailing Address - Fax:
Practice Address - Street 1:68 35TH ST STE C-556
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232-2019
Practice Address - Country:US
Practice Address - Phone:718-622-4058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist