Provider Demographics
NPI:1225679426
Name:FULTON, JUSTINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JUSTINE
Middle Name:
Last Name:FULTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JUSTINE
Other - Middle Name:
Other - Last Name:BENEDICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 LAUREN LN
Mailing Address - Street 2:
Mailing Address - City:NEW EGYPT
Mailing Address - State:NJ
Mailing Address - Zip Code:08533-1820
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:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ616400103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical