Provider Demographics
NPI:1811268980
Name:SULLIVAN, MARY E (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:E
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E HACKBERRY AVE RM C-204
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-6502
Mailing Address - Country:US
Mailing Address - Phone:956-618-7100
Mailing Address - Fax:
Practice Address - Street 1:901 E HACKBERRY AVE RM C-204
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-6502
Practice Address - Country:US
Practice Address - Phone:956-618-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-22
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3407-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical