Provider Demographics
NPI:1821562455
Name:SULLIVAN, SYDNEY (BCBA)
Entity Type:Individual
Prefix:MISS
First Name:SYDNEY
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:EAST BROOKFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01515-9800
Mailing Address - Country:US
Mailing Address - Phone:413-459-9565
Mailing Address - Fax:
Practice Address - Street 1:103 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:EAST BROOKFIELD
Practice Address - State:MA
Practice Address - Zip Code:01515-9800
Practice Address - Country:US
Practice Address - Phone:413-459-9565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2023-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
MA1-20-44781103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist