Provider Demographics
NPI:1114560893
Name:THE FULTON CENTER FOR VALUED LIVING, LLC
Entity Type:Organization
Organization Name:THE FULTON CENTER FOR VALUED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FULTON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:732-330-9440
Mailing Address - Street 1:445 BRICK BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-6080
Mailing Address - Country:US
Mailing Address - Phone:908-415-6354
Mailing Address - Fax:
Practice Address - Street 1:445 BRICK BLVD STE 302
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-6080
Practice Address - Country:US
Practice Address - Phone:908-415-6354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health