Provider Demographics
NPI:1801903000
Name:SULLIVAN, CYNTHIA LUCK (PHD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:LUCK
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:LUCK
Other - Last Name:D'ARMAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3338 CONQUISTADOR CT
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-1116
Mailing Address - Country:US
Mailing Address - Phone:703-851-7109
Mailing Address - Fax:202-745-2235
Practice Address - Street 1:3020 HAMAKER CT STE 103
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2220
Practice Address - Country:US
Practice Address - Phone:703-876-0966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002968103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC492151Medicare PIN