Provider Demographics
NPI:1407145246
Name:O'SULLIVAN, CATHY ANN (LMSW)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:ANN
Last Name:O'SULLIVAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5403 69TH ST
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-1804
Mailing Address - Country:US
Mailing Address - Phone:917-502-7578
Mailing Address - Fax:
Practice Address - Street 1:394 HENDRIX ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-3611
Practice Address - Country:US
Practice Address - Phone:718-485-2100
Practice Address - Fax:718-485-2269
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077418104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker