Provider Demographics
NPI:1275179764
Name:VICTORIA ANN SULLIVAN LCSW PLLC
Entity Type:Organization
Organization Name:VICTORIA ANN SULLIVAN LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSWR
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWR
Authorized Official - Phone:845-618-5242
Mailing Address - Street 1:31 CAROL DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-5210
Mailing Address - Country:US
Mailing Address - Phone:845-618-5242
Mailing Address - Fax:877-224-9708
Practice Address - Street 1:677 STATE ROUTE 17M
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-3318
Practice Address - Country:US
Practice Address - Phone:845-618-5242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty