Doctor Name: | DR. CHARLES D SULLIVAN |
NPI Number: | 1144433863 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHD |
License Number: | 355100121900 |
Business Practice Address: | 265 Route 46 West Suite 202 Totowa, NJ - 07512 |
Business Phone Number: | 9732562818 |
Business Fax Number: | 9732562818 |
Mailing Address: | 265 Route 46 West, Suite 202 TOTOWA |
State: | NJ |
Postal Code: | 07512 |
Phone Number: | 9732562818 |
Fax Number: | 9732562818 |
NPI Enumeration Date: | 05/08/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 355100121900 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |