Provider Demographics
NPI:1134852601
Name:SULLIVAN, LILYANA MARY (LMSW)
Entity type:Individual
Prefix:MRS
First Name:LILYANA
Middle Name:MARY
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 TREDWELL AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3049
Mailing Address - Country:US
Mailing Address - Phone:631-747-0907
Mailing Address - Fax:
Practice Address - Street 1:101 LAUREL RD
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-1415
Practice Address - Country:US
Practice Address - Phone:516-962-1191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-02
Last Update Date:2022-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker