Provider Demographics
NPI:1548406549
Name:O' SULLIVAN, MACDARA (LMSW)
Entity Type:Individual
Prefix:MR
First Name:MACDARA
Middle Name:
Last Name:O' SULLIVAN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 STUYVESANT OVAL APT 5E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-2217
Mailing Address - Country:US
Mailing Address - Phone:212-677-4104
Mailing Address - Fax:
Practice Address - Street 1:12 STUYVESANT OVAL APT 5E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-2217
Practice Address - Country:US
Practice Address - Phone:212-677-4104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-21
Last Update Date:2008-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074501-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker