Provider Demographics
NPI:1144554973
Name:FULCHER, REBECCA LYNN (PSYD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:LYNN
Last Name:FULCHER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LEFRAK CITY PLZ
Mailing Address - Street 2:ROOM 1525
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-4160
Mailing Address - Country:US
Mailing Address - Phone:718-760-7554
Mailing Address - Fax:
Practice Address - Street 1:3259 CATLIN AVE
Practice Address - Street 2:
Practice Address - City:QUANTICO
Practice Address - State:VA
Practice Address - Zip Code:22134-5109
Practice Address - Country:US
Practice Address - Phone:703-784-1779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-26
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018071-1103TC0700X
VA0810005162103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical