Provider Demographics
NPI:1336514314
Name:SULLIVAN, CAITLIN (MS)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 SMOKE RISE CIR
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712-1047
Mailing Address - Country:US
Mailing Address - Phone:203-695-5762
Mailing Address - Fax:
Practice Address - Street 1:51 SMOKE RISE CIR
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:CT
Practice Address - Zip Code:06712-1047
Practice Address - Country:US
Practice Address - Phone:203-695-5762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool