Healthcare Provider Details

I. General information

NPI: 1285006734
Provider Name (Legal Business Name): ELEANOR KENT FULTON PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELEANOR KENT HEINER PSY.D.

II. Dates (important events)

Enumeration Date: 10/23/2015
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 GREAT RD
ACTON MA
01720-3415
US

IV. Provider business mailing address

532 GREAT RD
ACTON MA
01720-3415
US

V. Phone/Fax

Practice location:
  • Phone: 978-263-0439
  • Fax:
Mailing address:
  • Phone: 978-263-0439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7814
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: