Provider Demographics
NPI:1073734893
Name:ROY SULLIVAN, FIONA KATE (PHD)
Entity Type:Individual
Prefix:DR
First Name:FIONA
Middle Name:KATE
Last Name:ROY SULLIVAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 WOODSTONE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532-1047
Mailing Address - Country:US
Mailing Address - Phone:508-393-0047
Mailing Address - Fax:
Practice Address - Street 1:621 MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-5668
Practice Address - Country:US
Practice Address - Phone:508-397-2589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7599103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist