Provider Demographics
NPI:1942919774
Name:SULLIVAN, KATHRYN (PHD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 E 95TH ST APT 31E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-4024
Mailing Address - Country:US
Mailing Address - Phone:610-945-8022
Mailing Address - Fax:
Practice Address - Street 1:1 N BROADWAY
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-2310
Practice Address - Country:US
Practice Address - Phone:914-385-1150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist