Provider Demographics
NPI:1760705735
Name:FULLEN, JOSEPH (ACDP, ICADC, LMHC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:FULLEN
Suffix:
Gender:M
Credentials:ACDP, ICADC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 553
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-0553
Mailing Address - Country:US
Mailing Address - Phone:401-516-4204
Mailing Address - Fax:
Practice Address - Street 1:20 HAMILTON DR
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-2109
Practice Address - Country:US
Practice Address - Phone:401-516-4204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00788101YM0800X
RICDP00201101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)