Provider Demographics
NPI:1326685744
Name:SULLIVAN, MEGAN CLAIRE (MED, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:CLAIRE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 GREEN HILL RD
Mailing Address - Street 2:
Mailing Address - City:PAWLET
Mailing Address - State:VT
Mailing Address - Zip Code:05761-9442
Mailing Address - Country:US
Mailing Address - Phone:609-315-9201
Mailing Address - Fax:
Practice Address - Street 1:900 GREEN HILL RD
Practice Address - Street 2:
Practice Address - City:PAWLET
Practice Address - State:VT
Practice Address - Zip Code:05761-9442
Practice Address - Country:US
Practice Address - Phone:609-315-9201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-04
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1460134163103K00000X
NY003421103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst