Provider Demographics
NPI:1285006734
Name:FULTON, ELEANOR KENT (PSYD)
Entity type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:KENT
Last Name:FULTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ELEANOR
Other - Middle Name:KENT
Other - Last Name:HEINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:532 GREAT RD
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3415
Mailing Address - Country:US
Mailing Address - Phone:978-263-0439
Mailing Address - Fax:
Practice Address - Street 1:532 GREAT RD
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3415
Practice Address - Country:US
Practice Address - Phone:978-263-0439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-23
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7814103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical