Provider Demographics
NPI:1508298035
Name:MARK AND BARBARA SULLIVAN PSYCHOTHERAPY INC
Entity Type:Organization
Organization Name:MARK AND BARBARA SULLIVAN PSYCHOTHERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:STEVENS
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:510-258-3068
Mailing Address - Street 1:2635 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2131
Mailing Address - Country:US
Mailing Address - Phone:510-540-0548
Mailing Address - Fax:
Practice Address - Street 1:2635 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2131
Practice Address - Country:US
Practice Address - Phone:510-540-0548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW 3295251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health