Provider Demographics
NPI:1306556915
Name:FOGARTY, ADRIAN (LMHC)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:
Last Name:FOGARTY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 ENTERPRISE TER
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02881-1834
Mailing Address - Country:US
Mailing Address - Phone:401-440-5044
Mailing Address - Fax:
Practice Address - Street 1:108 ENTERPRISE TER
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:RI
Practice Address - Zip Code:02881-1834
Practice Address - Country:US
Practice Address - Phone:401-440-5044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2024-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MALMHC10002449101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health