Provider Demographics
NPI:1740082981
Name:LEO SULLIVAN MENTAL HEALTH COUNSELOR P.C.
Entity type:Organization
Organization Name:LEO SULLIVAN MENTAL HEALTH COUNSELOR P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPORTS AND MENTAL PERFORMANCE COUNS
Authorized Official - Prefix:MR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:516-428-9881
Mailing Address - Street 1:19 CAROLINE CT
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-1823
Mailing Address - Country:US
Mailing Address - Phone:516-428-9881
Mailing Address - Fax:
Practice Address - Street 1:19 CAROLINE CT
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-1823
Practice Address - Country:US
Practice Address - Phone:516-428-9881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty