Provider Demographics
NPI:1245548197
Name:SULLIVAN, CHRISTINE E (LMSW)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:E
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:E
Other - Last Name:MCCANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:2 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-3825
Mailing Address - Country:US
Mailing Address - Phone:917-364-0346
Mailing Address - Fax:
Practice Address - Street 1:2 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-3825
Practice Address - Country:US
Practice Address - Phone:917-364-0346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081860104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker