Provider Demographics
NPI:1598371734
Name:SULLIVAN, CRISTINA MARIE SOTO (PHD)
Entity Type:Individual
Prefix:DR
First Name:CRISTINA
Middle Name:MARIE SOTO
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CRISTINA
Other - Middle Name:
Other - Last Name:SOTO SULLIVAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2524 E WEBSTER PL STE 203
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-4257
Mailing Address - Country:US
Mailing Address - Phone:414-964-9200
Mailing Address - Fax:
Practice Address - Street 1:2524 E WEBSTER PL STE 203
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4257
Practice Address - Country:US
Practice Address - Phone:414-964-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3846103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist