Healthcare Provider Details

I. General information

NPI: 1538489612
Provider Name (Legal Business Name): BRITTANY NICOLE FULTON M.A., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SAUNDERS WAY SUITE 900
WESTBROOK ME
04092-4833
US

IV. Provider business mailing address

5 BRIDGE ST
TOPSHAM ME
04086-1942
US

V. Phone/Fax

Practice location:
  • Phone: 207-878-9663
  • Fax:
Mailing address:
  • Phone: 630-725-8157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: