Provider Demographics
NPI:1629144233
Name:SULLIVAN, LAUREN POLICASTRO (MA, LPC, ACS)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:POLICASTRO
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MA, LPC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 FIELD RD
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-3301
Mailing Address - Country:US
Mailing Address - Phone:973-229-6458
Mailing Address - Fax:
Practice Address - Street 1:28 MILLBURN AVE STE 9
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1023
Practice Address - Country:US
Practice Address - Phone:973-229-6458
Practice Address - Fax:973-909-8320
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00312800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional