Provider Demographics
NPI:1457137838
Name:SULLIVAN, DAVID A (BCBA)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:A
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 TACKLE AVE
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2265
Mailing Address - Country:US
Mailing Address - Phone:856-803-9452
Mailing Address - Fax:
Practice Address - Street 1:1187 LAKEWOOD FARMINGDALE RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-8689
Practice Address - Country:US
Practice Address - Phone:844-525-5226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-20-46295103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst