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Individual

MRS. JACLYN JOANN SULLIVAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MA, LMFT

Contact information

Practice address
191 BROADWAY, AMITYVILLE, NY 11701-2790
(516) 662-1158
Mailing address
1024 N HAMILTON AVE, LINDENHURST, NY 11757-2129
(516) 662-1158

Taxonomy

Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary

Other

Enumeration date
09/28/2012
Last updated
07/16/2015
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