Individual
DR. CHARLES D SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
265 ROUTE 46 WEST, SUITE 202, TOTOWA, NJ 07512
(973) 256-2818
(973) 256-2818
Mailing address
265 ROUTE 46 WEST, SUITE 202, TOTOWA, NJ 07512
(973) 256-2818
(973) 256-2818
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
355100121900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1282905
—
NJ
Enumeration date
05/08/2007
Last updated
07/08/2007
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