Provider Demographics
NPI:1265554182
Name:SULLIVAN, LAWRENCE (NCPSYA)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:NCPSYA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 E 88TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-2273
Mailing Address - Country:US
Mailing Address - Phone:212-289-4530
Mailing Address - Fax:
Practice Address - Street 1:141 E 88TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-2273
Practice Address - Country:US
Practice Address - Phone:212-289-4530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000284102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000284OtherSTATE LICENSE