| Doctor Name: | DR. MARY P SULLIVAN |
| NPI Number: | 1184939100 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSYD |
| License Number: | PSY1190 |
| Business Practice Address: | 79-1020 Haukapila St Kealakekua, HI - 967507922 |
| Business Phone Number: | 8089366746 |
| Business Fax Number: | |
| Mailing Address: | 79-1020 Haukapila St, KEALAKEKUA |
| State: | HI |
| Postal Code: | 967507922 |
| Phone Number: | 8089366746 |
| Fax Number: | |
| NPI Enumeration Date: | 08/13/2010 |
| NPI Last Update Date: | 08/13/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PSY1190 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | HI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |