Provider Demographics
NPI:1467519231
Name:O'SULLIVAN, JOAN ANNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:ANNE
Last Name:O'SULLIVAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CRANE AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-3702
Mailing Address - Country:US
Mailing Address - Phone:914-798-1108
Mailing Address - Fax:914-422-8123
Practice Address - Street 1:52 N BROADWAY
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603-3710
Practice Address - Country:US
Practice Address - Phone:914-798-1108
Practice Address - Fax:914-422-8123
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012102-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist