Provider Demographics
NPI:1609658962
Name:SULLIVAN, RAYMOND DAVID (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:DAVID
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:RAY
Other - Middle Name:
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 5591
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93150-5591
Mailing Address - Country:US
Mailing Address - Phone:805-689-2233
Mailing Address - Fax:
Practice Address - Street 1:5276 HOLLISTER AVE STE 205
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-3066
Practice Address - Country:US
Practice Address - Phone:805-392-8057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94027027018103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical