Provider Demographics
NPI:1497915003
Name:SULLIVAN, MEGAN BOYLAN (LPC,LCADC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:BOYLAN
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LPC,LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 MILLER DR
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-1003
Mailing Address - Country:US
Mailing Address - Phone:732-261-9655
Mailing Address - Fax:
Practice Address - Street 1:320 AMBOY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2469
Practice Address - Country:US
Practice Address - Phone:732-205-0092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00129400101YA0400X
NJ37PC00166100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)